Role of the endovascular surgery in the management of the bullet emboli to the heart and major vessels: A summary

Bullet emboli are relatively rare complications of gunshot wounds in both the military and civilian populations. The rarity of these cases could not provide a suitable basis for clinical practice guidelines, and no universal clinical treatment algorithms are presented in the literature. This summary for the previously paper ‘Successful Surgical Management of Cardiac Bullet Emboli’ will allow us to present a short review of the endovascular management of bullet embolism. Rapid development and technical advances in the field of endovascular surgery provide an indispensable treatment tool, whose role should be presented in a more detailed fashion than in the original publication. Shannon et al. (1987) published a case of hepatic vein bullet embolism treated by percutaneous transvenous basket relocation and extraction through the femoral vein; 102 cases of venous bullet emboli since 1930 were found in the literature. Another review of the bullet emboli to the systemic and venous circulation was published by Michelassi et al. (1990). The authors were able to find only 153 cases reported at the time of publication. They stated that arterial bullets were symptomatic in 80% of cases and venous in only one third. Non-symptomatic bullets must be removed because of the risk of possible spontaneous migration and further embolization.