Background <p>Intertrochanteric fractures in elderly patients are prevalent in trauma orthopedics and constitute a significant cause of mortality among the elderly population. Proximal Femoral Nail Antirotation (PFNA) is recognized as the standard treatment modality for these fractures. While the prevention of lower limb venous thrombosis is a major clinical focus, postoperative femoral artery thrombosis remains exceedingly rare; however, it can lead to severe disability or even death if not managed promptly.</p> Methods <p>This case report discusses an 83-year-old male patient with sarcopenia and chronic obstructive pulmonary disease (COPD) who sustained an intertrochanteric fracture due to an accidental fall during hospitalization. The patient successfully underwent PFNA surgery. However, immediate postoperative findings indicated localized swelling in the left thigh, decreased skin temperature below the left knee, and non-palpable left popliteal, posterior tibial, and dorsalis pedis arteries, along with weakness in dorsiflexion of the left ankle and toes. Emergency bedside Doppler color ultrasound and lower limb CT angiography (CTA) revealed thrombosis of the superficial femoral artery with complete vascular occlusion. An interventional radiologist promptly performed percutaneous lower limb arterial thrombectomy and arterial balloon angioplasty. Postoperatively, the skin temperature of the affected limb returned to normal, and the popliteal, posterior tibial, and dorsalis pedis arteries became palpable. The mobility of the left ankle joint gradually returned to normal.</p> Results <p>Post-surgery, the patient’s hip pain significantly improved. Follow-up X-rays demonstrated satisfactory fracture reduction with effective internal fixation. No significant lower limb swelling, sensory deficits, or foot drop were observed.</p> Conclusion <p>Surgeons must maintain a heightened awareness of the potential complications associated with arterial thrombosis in the context of fractures. The formation of femoral artery thrombosis in this patient may be attributed to prolonged compression of the proximal femoral artery during intraoperative fracture reduction, compounded by the patient’s long-standing sarcopenia and COPD. These factors likely contributed to elevated levels of inflammatory markers and increased susceptibility to complications. Furthermore, pre-existing peripheral arterial disease, perioperative hypotension, hypercoagulable state, embolic disease, plaque instability, or trauma-associated vascular injury cannot be excluded as potential causative factors. It is imperative to conduct comprehensive preoperative screenings and to employ meticulous and gentle surgical techniques, particularly in elderly patients, to minimize the risk of complications. Furthermore, thorough and timely physical examinations before and after surgery are essential for the early detection of problems and improved patient outcomes. Lastly, clinical practice should enhance fall prevention strategies for elderly patients suffering from sarcopenia.</p>