Emergency vascular access in a patient with limb agenesis

A 19-year-old white man with congenital agenesis of all four limbs arrived in the emergency room in full cardiopulmonary arrest secondary to Reye's syndrome. The patient was intubated but had no vascular access. After a percutaneous femoral venous line proved unsuccessful, an internal jugular line was placed for venous access. Repeated attempts at percutaneous femoral and axillary arterial line placements were unsuccessful. A femoral cutdown showed 2-mm femoral vessels. The autopsy showed increasingly hypoplastic aortic, iliac, and femoral vessels below the takeoff of the renal vessels. The subclavian vessels were reasonably normal in caliber. This case shows that femoral or axillary vessels in a congenitally amputated limb are not useful for vascular access, and a low threshold should exist for using internal jugular/subclavian veins and the subclavian/carotid arteries if emergency access is necessary.