Transoral crossbow injury to the cervical spine: an unusual case of penetrating cervical spine injury.

The complexity of missile injuries to the cervical spine has increased as the technology that causes these injuries has become more sophisticated. Management requires adaptation of conventional neurosurgical approaches to the cervical spine in an effort to limit neurological deficit and establish stability. We report an unusual case of a 19-year-old man who suffered transoral penetration of the cervical spine by an arrow released by a crossbow at close range.

Inflow atherosclerotic disease localized to the common femoral artery: treatment and outcome.

Severe occlusive disease of the common femoral artery without significant aortoiliac disease is not common in our experience. Since 1978 we have operated upon 29 limbs in 22 patients (mean age 60) with localized common femoral artery disease. Indications for operation were claudication in 31% and impending limb loss in 69%. Operations included common femoral artery endarterectomy with patch angioplasty (19 limbs), patch angioplasty alone (two limbs), and common femoral artery endarterectomy without a patch (three limbs). Operative mortality was zero; there were nine wound complications, one patient had a myocardial infarction with early thrombosis. Symptomatic relief was obtained in 20 of 22 patients. All minor amputations healed. The mean postoperative ankle/brachial index increased to 0.67 from 0.49. Mean follow-up is 37 months (one-118 months); there have been 10 late deaths. Cumulative two and five year patency rates are 82% and 74%, limb salvage is 80% and 80%, respectively. Major amputations were required in five patients at two, two, 12, 23, and 68 months. Further inflow procedures were required in four patients: three aortobifemoral bypasses and one axillofemoral bypass. Although this disease has an uncommon inflow level, it is amenable to safe, durable, local procedures.