Peripheral arterial missile embolization: a case report and 22-year literature review

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.