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Bullet embolism
K R Patel1, L E Cortes, L Semel
1New York Medical College, Metropolitan Hospital Center, New York.
Insights
Bullet embolism, a rare vascular trauma complication, occurred in six patients over ten years. Successful surgical repair and emboli removal, or conservative management, led to complete recovery in all cases.
Area of Science:
- Vascular Surgery
- Trauma Management
- Cardiovascular Medicine
Background:
- Bullet embolism is an infrequent yet serious complication following vascular trauma.
- Prompt diagnosis and management are crucial for patient outcomes.
Observation:
- Six patients with bullet embolism resulting from vascular trauma were treated over a decade.
- Injuries involved the inferior vena cava, aorta, and peripheral vessels, with emboli migrating to the heart, pulmonary arteries, or lower extremities.
- One case involved shotgun injury with both arterial and venous embolization.
Findings:
- All six patients underwent successful repair of the primary vascular injury.
- Peripheral arterial bullet emboli were removed in most cases, with one asymptomatic embolus left in place.
- Intracardiac and pulmonary artery bullet emboli were surgically removed, while distal pulmonary emboli were managed conservatively.
- All patients survived without complications.
Implications:
- This study highlights effective management strategies for bullet embolism, including surgical repair and emboli retrieval or conservative observation.
- Early recognition and intervention can lead to excellent patient outcomes, even with complex emboli locations.
- A comprehensive literature review underscores the rarity and key features of this pathology.
Abstract:
Bullet embolism is a rare complication of vascular trauma. During the last ten years we have treated six patients with bullet embolism. Three patients had inferior vena caval injuries with embolizations of the bullets to the heart or pulmonary arteries. Two had infrarenal aortic injuries with embolization to vessels of the lower extremities. One patient with a shotgun injury to the superficial femoral artery and vein had both arterial and venous embolizations. The site of vascular penetration was repaired in all six patients. All peripheral arterial bullet emboli were removed except for an asymptomatic shotgun pellet in the peroneal artery. One bullet was removed from a right atrium and another from a proximal pulmonary artery. Emboli in the distal pulmonary artery branches were left undisturbed in two patients. All six patients survived without any complications. A 14-year review of the literature is presented in order to emphasize some important features of this rare pathology.