Carotid endarterectomy (CEA) is the gold-standard method of carotid revascularization in symptomatic patients with ≥50% and in asymptomatic patients with ≥70% stenosis. Transfemoral carotid artery stenting (TFCAS) has been associated with higher perioperative stroke rates compared to CEA in several studies. On the other hand, transcarotid artery revascularization (TCAR) has outperformed TFCAS in patients who are considered high risk for surgery. There is increasing data that supports TCAR as a safe and efficient technique with outcomes similar to those of CEA, but additional level-one studies are necessary to evaluate the long-term outcomes of TCAR in high- and standard-risk patients.

Gunshot wounds are rising in incidence, morbidity, and mortality. It is thought that about half of nonfatal injuries occur in an extremity. Although the incidence is not known, arterial vasospasm can result in acute limb ischemia. We present the case of a 33-year-old man who suffered a gunshot wound to the left lower extremity resulting in arterial vasospasm of the superficial femoral artery. He quickly regained arterial flow, and we were able to manage his acute limb ischemia nonoperatively and to document restoration of flow through serial examinations and Doppler imaging. He was subsequently discharged the next day and is experiencing a full recovery.