Pellet Embolization after Subclavian Artery Injury:A Case Report
作者机构：Faculty of MedicineLithuanian University of Health SciencesKaunasLithuania Department of SurgeryUniversity College Hospital GalwayGalwayIreland Department of CardiacThoracic and Vascular SurgeryLithuanian University of Health SciencesHospital of Lithuanian University of Health Sciences Kaunas ClinicsKaunasLithuania
出 版 物：《Surgical Science》 (外科学（英文）)
年 卷 期：2017年第8卷第10期
页 面：444-450页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Gunshot Wound Pellet Embolization Arterial Trauma Upper Extremity Case Report
摘 要：Acute upper limb ischemia caused by a gunshot penetrating vascular injury and subsequent arterial embolization by foreign body is uncommon in everyday practice and is associated with high morbidity/mortality rates, especially with emergency surgery. We present the case of a 72-year old male who attempted suicide using a gun. A gunshot entry wound was evident in the right upper chest region with no pellet exit wound. Radial pulses were palpable bilaterally. Angiography revealed right subclavian artery direct injury and pellet embolization to the brachial artery. The patient underwent open surgery, with reversed saphenous vein interposition graft to replace subclavian artery defect. A pellet was removed by a separate arteriotomy in the brachial artery. Associated injuries were clavicle-comminuted fracture and subclavian vein injury. The patient remained well 5 months later with no reported complications. In conclusions, the presence of radial pulses alone on clinical exam cannot rule out the presence of a significant vascular injury.
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