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Related Experiment Videos

Venous bullet embolism: rationale for mandatory extraction.

F L Shannon1, B L McCroskey, E E Moore

  • 1Department of Surgery, Denver General Hospital, CO 80204.

The Journal of Trauma
|October 1, 1987
PubMed
Summary

Venous missile embolism, a rare trauma complication, can be safely treated with modern percutaneous techniques. Early extraction prevents complications and migration, offering a favorable prognosis for retained projectiles.

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Area of Science:

  • Traumatology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Venous missile embolism is a rare but serious complication of penetrating trauma.
  • Management options for venous bullet emboli remain controversial.
  • Retained projectiles can lead to significant morbidity.

Observation:

  • A case of hepatic vein bullet embolism successfully treated with percutaneous transvenous basket relocation and extraction via femoral vein cutdown is presented.
  • A review of 102 reported bullet emboli since 1930 was conducted.
  • Modern techniques for bullet emboli removal demonstrate low complication rates.

Findings:

  • Early extraction of venous bullet emboli is associated with favorable outcomes.
  • Key steps in early extraction include preventing proximal migration, transvenous relocation to an accessible vein, and peripheral surgical removal.

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  • Delayed recognition of asymptomatic bullet emboli requires careful consideration for selective operative removal.

    • Implications:

    • Percutaneous transvenous techniques offer a safe and effective treatment for venous missile embolism.
    • A management scheme considering time of recognition, patient status, and embolus characteristics is proposed.
    • Minimally invasive approaches should be considered for the management of venous bullet emboli.