The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not entirely benign instrument. A case is desribed in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 1963 the Fogarty ballon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause. It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehensive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.

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Gunshot wounds of either the heart or thoracic aorta with subsequent embolism of the bullet in a peripheral artery are rare. A thorough examination of medical literature published since 1885 revealed 53 cases of thoracic gunshot wounds in which the missile lodged as an embolus in the peripheral arterial tree. In only 19 of these cases was the heart the site of bullet entry. The rarity of a bullet embolus in a peripheral artery following a gunshot wound of the heart has prompted us to report the following fascinating case: Case Report A 23 year-old man was brought to the emergency room shortly after sustaining gunshot wounds of the head, abdomen, and thigh.Physical examination revealed that the patient was in a state of shock with no palpable pulse or detectable blood pressure. There was a bullet wound in the left temple with ecchymosis surrounding the left eye. Another bullet had entered the left upper abdomen at the level of the umbilicus in the left anterior axillary line (Figure 1). A third bullet had entered and exited through the anterolateral aspect of the left thigh.Auscultation revealed diminished breath sounds over the left chest. Examination of the heart revealed a tachycardia of 120 per minute. Heart sounds were normal in quality. The abdominal entry wound was further examined ; palpation revealed the left side of the abdomen to be soft with moderate tenderness. Bowel sounds were normal. The lower left extremity was cold and appeared mottled in its lower part, and there were no palpable pulses in the left leg. Rectal examination was unremarkable. There was no neurologic deficit.Following resuscitation with intravenous fluids, appropriate roentgenographic studies were performed. Skull films showed bullet fragments extracranially and a fracture of the left temporal bone. A chest film revealed a left hemothorax (Figure 2). A plain film of the abdomen showed an intact 0.45 caliber bullet positioned in the left side of the lower abdomen (Figure 3). X-ray examination of the left thigh was unremarkable. Hospital CourseInitial management included intravenous administration of colloids and the passage of a nasogastric tube and Foley catheter, neither of which revealed the presence of blood. A chest tube inserted on the left side retrieved 1200 cc of blood.The patient was taken to the operating room within an hour of admission. The abdomen was entered through a midline incision. Exploration revealed at FLORIDA INTERNATIONAL UNIV on June 20, 2015 ves.sagepub.com Downloaded from