Variability in evolution and course of gunshot injuries to the neck and impact on management. A case report.

This study reports the differences in evolution and course of multiple pseudoaneurysms (PAs) and an axillary arteriovenous fistula (AVF) after penetrating vascular trauma due to shotgun injury to the head and neck. We describe the unusual case of a young man who, following penetrating shotgun injuries to the head and neck, developed multiple PAs of the common carotid, vertebral and superficial temporal arteries as well as an axillary AVF. Serial angiographic follow-up studies documented differences in time of occurrence, evolution and course of these lesions. This allowed for tailored management using endovascular (AVF, superficial temporal artery PAs) and conservative (carotid and vertebral PAs) treatment. No complication occurred and complete cure of all lesions was achieved and documented after seven months. Time of occurrence, evolution and regression of penetrating vascular injuries can differ significantly even in the same patient. Close angiographic follow-up helps not only detect a lesion with delayed occurrence, but also provides a practical basis for decision-making for optimal therapeutic management.