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.

No abstract

Radiation injury is an uncommon but increasingly important cause of arterial insufficiency. Radiation-induced vascular compromise can threaten limbs once thought salvaged by radiotherapy in the course of treating neoplasms. Two cases of latent arterial occlusion secondary to radiotherapy are reported. The alteration of tissue architecture surrounding this type of arterial injury requires a different approach to vascular repair afforded only by extraanatomic bypass grafting.

No abstract

Since the ischemia/reperfusion syndrome may be associated with generation of oxygen free radicals (OFR), this study was designed to evaluate the effects of OFR inhibitors (allopurinol, superoxide dismutase) on the hemodynamic parameters associated with aortic clamping and shock.Normotensive animals showed minimal hemodynamic changes following a two-hour clamping and declamping of the aorta. Hypotensive occlusion was, however, associated with significant myocardial depression one hour after clamping in control and treated animals. No other major hemodynamic changes were noted between various groups at various phases of the experiment.The authors conclude that (1) myocardial depression occurs mainly with hypotensive occlusion and (2) OFR are not involved in these hemodynamic changes. The latter may be related to myocardial dysfunction secondary to hypovolemia.