title: Peripheral arterial missile embolization: a case report and 22-year literature review.
abstract: The present case report is that of an air pistol missile injury with perforation of a common femoral artery and subsequent arterioarterial embolization to the anterior tibial artery. Included in this report is a review and analysis of a 22-year experience in the vascular trauma literature with missile injuries resulting in cardioarterial or arterioarterial embolization. In-depth analysis of this collective literature review revealed small weapon caliber (79%), usually .22. Soft tissue tamponade at the injury site in the form of mediastinal hematoma, retroperitoneal hematoma, or hemopericardium preventing exsanguination occurred in 37% of cases. Cardiac and thoracic aortic entry sites represented 70% of the series with distinct patterns of peripheral vascular embolization found resulting from anatomic relationships and laminar flow. Diagnostic evaluation by means of remote x-ray screening documented 86% of the emboli and was supplemented with arteriographic studies in 36%. Direct transverse arteriotomy overlying the projectile was favored; most of the delayed embolectomies stemmed from a failure to recognize those patients with peripheral embolization and a compensated asymptomatic limb. An appropriate management plan and diagnostic algorithm for this rare vascular phenomenon have been generated by this study.
mesh_terms: D000293:Adolescent; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004630:Emergencies; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005548:Foreign-Body Migration / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007869:Leg Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery