# Hybrid treatment of penetrating trauma of the thoraco-abdominal aorta with bullet embolism to the popliteal artery - case report

## TL;DR

This case report describes a 16-year-old boy with a rare gunshot wound complication where a bullet traveled to his popliteal artery and a hybrid surgical approach was used to treat his injuries.

## Contribution

The paper presents a novel case of hybrid surgical treatment for a complex ballistic embolism and thoraco-abdominal aortic trauma.

## Key findings

- Hybrid surgery successfully treated a patient with a bullet embolism in the popliteal artery and aortic trauma.
- The case highlights the importance of recognizing ballistic embolism as a complication of low-velocity firearm injuries.
- Combining open and endovascular techniques can be effective for complex penetrating trauma.

## Abstract

Bullet embolism is a rare complication of gunshot wounds, but its incidence has increased due to the increasing number of wounds caused by low-velocity firearms in civilian settings. The increase in urban violence and widespread use of firearms with low-velocity projectiles have made diagnosis of ballistic embolism more common, so it is essential to recognize the risk factors for such events. Both treatment of the entry wound and removal of the ballistic embolism can be successfully performed by open, endovascular, or hybrid surgery, and the particularities of each case should be considered. We report the case of a 16-year-old male patient who presented with penetrating aortic trauma in addition to an intra-arterial firearm projectile in the right popliteal artery and underwent hybrid surgery to treat his injuries.

A embolia balística é uma complicação rara decorrente de ferimentos por arma de fogo, cuja incidência tem aumentado devido ao crescente número de lesões provocadas por projéteis de baixa velocidade no contexto civil. O aumento da violência urbana e o uso disseminado de armas de fogo com esse tipo de projétil tornam o diagnóstico de embolia balística mais frequente, tornando essencial o reconhecimento dos fatores de risco associados a esse evento. Tanto o tratamento do ferimento de entrada quanto a remoção do êmbolo balístico podem ser realizados com sucesso por via cirúrgica aberta, endovascular ou híbrida, devendo ser consideradas as particularidades de cada caso. Relatamos o caso de um paciente do sexo masculino, de 16 anos, que apresentou trauma penetrante de aorta, além da presença de projétil intra-arterial na artéria poplítea direita, submetido a abordagem híbrida para o tratamento das lesões.