title: Emergency endovascular management of penetrating gunshot injuries to the arteries in the face and neck: a case series and review of the literature.
abstract: BACKGROUND
  Penetrating gunshot injuries (GSI) to supra-aortic arteries that cause life-threatening blood loss or major neurologic deficits are increasingly managed using modern endovascular treatment (EVT). We report our experience with EVT of acute GSIs and review the existing literature.
  
  
  METHODS
  Emergency EVT was performed in nine of 10 patients (7 men, age 17-50 years) with acute GSIs to supra-aortic arteries requiring acute management. One patient presented with acute and delayed injuries and underwent EVT 4 weeks after initial admission. Patient selection was based on clinical presentation and radiographic findings from a cohort of 55 patients with GSIs to the face, neck or head between February 2009 and March 2012.
  
  
  RESULTS
  EVT was successfully performed in all patients. Two transections of the vertebral arteries were embolized with coils and/or liquid embolic agent (acrylic glue). Eight penetrated external carotid artery branches were occluded with liquid embolic agents (acrylic glue or Onyx) or particles. One severe dissection of the internal carotid artery with a subsequent thromboembolic event was treated with stenting. All except one patient survived with minor or no residual deficits.
  
  
  CONCLUSIONS
  Emergency management of GSI injuries to the head and neck may involve all aspects of current EVT. Understanding endovascular techniques and being able to make rapid and appropriate treatment decisions in the setting of acute GSI to the face and neck can be a life-saving measure and greatly benefits the patient's outcome.
authors.affiliation: Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Yevich
authors.forename: Stephen Robert
authors.initials: SR
authors.lastname: Lee
authors.forename: Bradford G
authors.initials: BG
authors.lastname: Scott
authors.forename: Hashem M
authors.initials: HM
authors.lastname: Shaltoni
authors.forename: Michel E
authors.initials: ME
authors.lastname: Mawad
authors.forename: Goetz
authors.initials: G
authors.lastname: Benndorf
mesh_terms: D000293:Adolescent; D000328:Adult; D019468:Disease Management; D004632:Emergency Medical Services / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005145:Face / Q000098:blood supply / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult