Extraction of an air gun projectile under angiologic safety procedure. A case report

Abstract

We report about a patient who was hit in the neck by an air gun bullet. He complained about neck pain radiating down his right shoulder. After radiological diagnostics we found a 4.5 mm bullet lying next to the neuroforamen C5/6 and right behind the vertebral artery.We decided to remove the projectile due to its proximity to the vertebral artery and the existing radicular pain. Before surgery we placed a 6F envoy inside the subclavian artery and a 0.014-inch wire into the vertebral artery up towards the level of C2. Therewith we got the possibility to stop any eventual bleeding caused by a pre-existing arterial injury from the projectile or in the event of iatrogenic vascular injury.During surgery we could extract the bullet underneath the vertebral artery after luxating the vessel with fine retractors. The vertebral artery was not injured and we did not need to occlude the vessel with the intravascular balloons.With this procedure we achieved the highest amount of security for the patient. We strongly recommend this procedure for similar cases. Keywords: Vertebral artery injury, Gunshot, Angiographic bleeding control, Angiography, Trauma, Safety procedure