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Objective: Review a single center experience with the use of stent-grafts, CT scans, and intravascular ultrasound to manage gunshot wounds (GSW’s) to the descending and paravisceral aorta.
Methods: From 1996 to 2015 records of patients undergoing endovascular repair of GSW’s to the aorta were identified. Presentation, diagnostic studies, management, and outcome were analyzed for each patient.
Results: Nine patients (6 males, 3 females) with an average age of 28.1 years were identified. All were hemodynamically stable on initial presentation, or responded to initial fluid resuscitation. Three presented with bullet embolization, with two of them having limb ischemia. Four had associated major injuries, which included: GSW to the left ventricle, GSW left hepatic lobe, aorto-caval fistula, and a blast injury to the mitral valve. Surgical intervention was required in three of them median sternotomy (n=1) and exploratory laparotomy (n=2) for their management of their associated injuries. Imaging studies included: CT scans (n=8), intra-operative angiography (n=9) and intravascular ultrasound (n=9). Angiograms with multiple views were negative in 2, CT was positive in 6, IVUS was able to identify the site of injury in all of them. Stent-grafts were deployed from femoral artery (n=7) or iliac artery (n=1). Celiac trunk coverage was required in one patient, which led to a gangrenous gallbladder requiring laparoscopic cholecystectomy 5 weeks later. All of them survived their injuries, and no secondary interventions have been required, with an average follow-up of 3.9 years (range 1.0 - 12.8).
Conclusions: GSW to the descending thoracic and paravisceral aorta are not always catastrophic on presentation. In the hemodynamically stable patient IVUS examination is sensitive and specific, and rapid stent-graft deployment appears to have a role in minimizing the complexity, morbidity and mortality of these injuries.