Odyssey from the street: a successful aortic arch replacement after firearm injury

This case report depicts a rare clinical scenario where emergency cardiac surgery was required following a firearm wound resulting in traumatic aortic arch injury. A penetrating injury of the aortic arch is a life-threatening condition with a high overall mortality rate. In this paper we present a 53-year-old male who presented to the emergency department after being shot. The patient's management started with a comprehensive assessment including contrast-enhanced computer tomography (CT) scan, crucial in delineating the precise anatomical extension of the injury. In our specific case, the CT-scan showed aortic arch upper wall rupture between the brachiocephalic arterial trunk and the left common carotid caused by a .22 calibre bullet without exit orifice from the mediastinum. The patient was rushed to the operating room for ascending aorta and aortic arch replacement with brachiocephalic artery reimplantation. The exceptional nature of this case lies not only in its infrequency but also in the surgical complexities amidst an emergent situation. Addressing this complexity demanded a multidisciplinary approach integrating meticulous preoperative planning and intraoperative dexterity to achieve a favourable outcome in high-stakes scenario.