ARTERIAL BULLET EMBOLISM RESULTING IN DELAYED VASCULAR INSUFFICIENCY - A RATIONALE FOR MANDATORY EXTRACTION

This paper reports a case of migrating intravascular bullet embolus th at initially produced no symptoms but resulted in an above-knee amputa tion 14 months after its entry into a peripheral artery. The missile e ntered through a penetrating gunshot wound to the abdominal aorta and later became lodged in the left popliteal artery. However, the bullet fragment migrated further into the posterior tibial artery with conseq uent vascular insufficiency requiring a supracondylar amputation of th e left lower extremity 14 months later. Emphasis is placed on the need for a high index of suspicion for bullet embolism, aggressive search for any bullets unaccounted for, and early surgical removal of all con firmed arterial emboli.