Endovascular treatment of descending aorta gunshot injury

Vascular injuries of the thoracic inlet and mediastinum present formidable difficulties in terms of exposure and management. The majority of patients with gunshot wounds to the thoracic aorta and brachiocephalic vessels do not reach the operating room alive, but those who do present unique problems for thoracic and vascular surgeons. In such cases, operative repair must be individualized and often must depend on experience with other elective cardiovascular procedures. This report details the management of a patient suffering wound to the superior thoracic region from a low-velocity hunting shotgun, involving superficial (skin and muscles) and deep tissues (heart and descending aorta). Some of the difficulties inherent in managing such an injury are