A 4 month old boy presents with traumatic amputations of all 4 distal extremities (at the knees and elbows), and requires invasive blood pressure monitoring intra-operatively. Which of the follow is an artery WITH collateral blood flow?
a) Femoral
b) Brachial
c) Subclavian
d) Temporal
e) Axillary
Answer e. The axillary artery has collateral blood flow. The axillary artery is a large central artery, and has conventionally been selected for arterial cannulation over other end arteries such as the femoral, brachial and temporal arteries. The subclavian artery is typically not chosen for arterial cannulation due to the risk of hematoma formation without the ability to apply compression to the vessel. Temporal artery (an end-artery arising from the external carotid artery) cannulation has been associated with cerebral emboli, and is infrequently used in contemporary medicine. Retrospective data have shown similar rates of temporary arterial occlusion and permanent ischemic injury when comparing femoral and axillary catheter complications rates. Although brachial arterial lines have been utilized in neonates, placement of these lines should only be undertaken with an understanding of the risks associated with ischemia and limb loss.