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A 4 month old boy presents with traumatic amputations of all 4 distal<br />
extremities (at the knees and elbows), and requires invasive blood pressure<br />
monitoring intra-operatively. Which of the follow is an artery WITH collateral<br />
blood flow?<br />
<br />
a) Femoral<br />
<br />
b) Brachial<br />
<br />
c) Subclavian<br />
<br />
d) Temporal<br />
<br />
e) Axillary<br />
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==Answer==<br />
Answer e. The axillary artery has collateral blood flow. The axillary artery is a<br />
large central artery, and has conventionally been selected for arterial cannulation<br />
over other end arteries such as the femoral, brachial and temporal arteries. The<br />
subclavian artery is typically not chosen for arterial cannulation due to the risk of<br />
hematoma formation without the ability to apply compression to the vessel.<br />
Temporal artery (an end-artery arising from the external carotid artery)<br />
cannulation has been associated with cerebral emboli, and is infrequently used in<br />
contemporary medicine. Retrospective data have shown similar rates of<br />
temporary arterial occlusion and permanent ischemic injury when comparing<br />
femoral and axillary catheter complications rates. Although brachial arterial<br />
lines have been utilized in neonates, placement of these lines should only be<br />
undertaken with an understanding of the risks associated with ischemia and limb<br />
loss.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
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