TRA 1. Unusual Injury of Common Iliac and Median Sacral Arteries After Airgun Shot With Distal Embolization of the Pellet: A Case Report

Abstract

We describe a case with distal embolization of a pellet into the popliteal artery after an airgun shot in the abdomen. Airguns produce low-velocity and low-powered shots, which is why many people do not perceive them to be dangerous. However, modern airgun pellets are capable of inflicting serious and sometimes life- threatening injuries. We present a case of a 37-year-old man after an airgun shot to the abdomen. The patient was admitted in hemorrhagic shock to a countryside hospital. General surgeons preformed explorative laparotomy to stop the bleeding but with no success. After this, the vascular surgeon was urgently mobilized from a nearby city. The patient was extremely unstable, with massive blood loss and multiple transfusions (10 units, 400 mL each). Therefore, we decided to perform angiography first. We verified traumatic lesions in the left common iliac and median sacral arteries, so two stent grafts were implanted to stop the bleeding—Advanta V12 (Getinge, Rastatt, Germany) 9/40 for the common iliac artery and Graftmaster (Abbott Vascular, Abbott Park, Ill) 4/19 for the median sacral artery. The pellet was not visible in the abdomen on radiography. The patient was discharged after 10 days. A computed tomography scan at 1-month follow-up showed no signs of endoleak, but the pellet was found in the middle part of the left popliteal artery (Fig 1). The patient had palpable pulses on both pedal arteries without any signs of ischemia. Nevertheless, we extracted the pellet by a posterior approach to the popliteal fossa, but the artery was so damaged that it had to be replaced with a conduit from small saphenous vein (Fig 2). Successful treatment of complex airgun shot injury was accomplished with staged endovascular and open surgery approaches. Firearm injuries of main arteries are not generally common in modern societies. Furthermore, lesions of major arterial vessels by airgun pellets are even rarer. However, these injuries remain concerning because of their small size; they can easily migrate across the entire vascular system. If they are not found within the impact area, they should be meticulously sought elsewhere. Multilevel arterial trauma is challenging for every vascular specialist, but with the advances in the endovascular field, we can perform fast and safe treatment to save the patient’s life.Fig 2Posterior approach to popliteal artery and pellet inside it (A), extracted pellet (B), and interposition of vein conduit to reconstitute popliteal artery (C).View Large Image Figure ViewerDownload Hi-res image Download (PPT)