Central venous catheter provides multiple venous access in critically ill patients for hemodynamic monitoring, fluid resuscitation, administration of inotropes, nutritional support, and hemodialysis . The complication rate is about 15% including mechanical (arterial puncture, pneumothorax, and hematoma), infectious, and thrombotic complications . Ultrasound guidance reduces the risk of mechanical complication, procedure failure, and shortens the time required for insertion . Arterial injury occurs in around 0.5 to 3.7% of cases in the form of hematoma, hemothorax, pseudoaneurysm, and arteriovenous fistula. The most common arterial injury associated with IJV cannulation is carotid artery puncture. Subclavian artery injury is a rare complication. The typical clinical presentation is a triad of IJV cannulation, hypotension, and X-ray evidence of hemothorax [3, 4]. Management guidelines in cases of arterial injury are not very clear. Open surgical repair involves extensive surgical dissection in critically ill patients. Percutaneous management offers a less invasive, less time consuming alternative in critically ill patients in emergencies. Literature search showed only a few case reports of percutaneous management of arterial injury following IJV cannulation. In one of the cases, the misplaced catheter intended to be put in IJV was detected on chest X-ray. When the catheter was removed after 2 days, there was a hemodynamic compromise that was managed with stent graft . In another case, a vascular plug was used to close the arterial injury that occurred during subclavian venous puncture . Comparison of percutaneous approach with open surgical approach found to be non-inferior in terms of success and better in safety. In a retrospective case series where endovascular approach using stent graft was compared with surgical approach for subclavian artery injuries (three of them caused by subclavian artery catheterization attempts), it was shown that blood loss (70 ± 12.2 mL vs 220 ± 56.1 mL; P < 0.01) and procedural time (132 ± 15 min vs 193 ± 15 min; P = 0.04) was lesser in endovascular group . There was no difference in patency rates between the two groups . Endovascular treatment obviates the need for surgical dissection preventing injury to the adjacent structures like vagus nerve, recurrent laryngeal nerve, phrenic nerve, and innominate vein . Careful selection of the patient is necessary as lesions that are focal and are at a good distance from the vertebral artery are amenable for endovascular therapy. In our case, we had a sick child with HUS, thrombocytopenia, and acute renal failure requiring renal replacement therapy had hemothorax following IJV catheter placement leading to hemodynamic instability which was managed with multiple blood products transfusions. In such cases, open repair is difficult due to critically ill status and severe thrombocytopenia. We went ahead with the endovascular approach as it is less invasive and less time consuming. We encountered the problems of undersized stent and its poor apposition to the vessel wall leading to stent migration which was successfully managed. Using stent in a growing child has its implications like in-stent restenosis; vessel growth to stent size remains a challenge in the future, though development of collaterals would ensure adequate limb growth and functioning.