Chronic Leg Ischemia Caused by Arterial Bullet Embolization

Area of Science:

• Vascular Surgery
• Trauma Surgery
• Radiology

Background:

• Intravascular bullet embolization is a rare occurrence following gunshot injuries, with fewer than 200 reported cases historically.
• High-energy military combat injuries typically involve significant tissue damage, making projectile embolization less common compared to civilian incidents.

Purpose of the Study:

• To report a rare case of chronic leg ischemia due to arterial bullet embolization in a military service member.
• To underscore the importance of recognizing bullet embolization as a potential complication in gunshot wound patients.

Main Methods:

• Case report of a 22-year-old military personnel with chronic leg ischemia.
• Diagnostic evaluation and surgical planning for a bullet obstructing the popliteal artery.

Main Results:

• A 21-mm bullet was identified as the cause of popliteal artery obstruction and chronic leg ischemia.
• The patient required elective vascular surgery for removal of the embolized projectile.

Conclusions:

• Physicians must maintain a high index of suspicion for intravascular bullet embolization in patients with gunshot wounds.
• Early detection and appropriate management of bullet embolization are crucial to prevent severe complications such as chronic limb ischemia.