Background: Critical ischemia of the lower limbs refers to the last stages of peripheral arterial disease. It is characterized by resting discomfort or trophic disorders such as ulceration, skin necrosis, or gangrene in the lower limbs. Critical ischemia corresponds to Leriche–Fontaine (LF) stages III-IV and Rutherford stages 4–6. The purpose of this study was to observe the patency and postoperative complications of patients who have had infra-inguinal surgical revascularization and compare the results based on the kind of graft utilized. Methods: The present study was designed as an observational retrospective cohort study, including all patients from 2018 to 2019 diagnosed with severe ischemia of the lower limbs who were hospitalized at the Vascular Surgery Clinic of the County Emergency Clinical Hospital of Targu Mures. Results: Patients with a polytetrafluoroethylene (PTFE) graft had a higher incidence of chronic obstructive pulmonary disease (p = 0.01), stage III LF (70.41% vs. 55.29%), p = 0.03), and a lower incidence of stage IV LF (29.95% vs. 44.71%, p = 0.03). As for complications, the PTFE group showed a lower incidence of bypass thrombosis (29.59% vs. 44.71%; p = 0.03) and graft infection (9.18% vs. 21.18%; p = 0.02), but no statistical significance in the event of bleeding (p = 0.40). Regarding the outcomes, no statistical significance was seen for below-the-knee amputations or death. However, the PTFE group had a lower incidence of above-the-knee amputations (11.22% vs. 24.71%; p = 0.01). At multivariate analysis, the PTFE graft is an independent predictor of primary patency at 6, 12, and 24 months (OR: 2.15, p = 0.02; OR: 1.84, p = 0.04; and OR: 1.89, p = 0.03), as well as a protective factor against bypass thrombosis (OR: 0.52; p = 0.03), graft infection (OR: 0.37; p = 0.02), and above-the-knee amputation (OR: 0.38; p = 0.01).; Conclusions: According to this study’s findings, there were minor differences regarding the long-term patency, bypass thrombosis, graft infections, and above-the-knee amputations. In addition, the PTFE graft group had a higher incidence of primary patency at 6, 12, and 24 months, as well as a lower incidence of bypass thrombosis, graft infection, and above-the-knee amputations.

Superficial thrombophlebitis of the lower limb is a common, frequent pathology, which most of the time does not require anticoagulant treatment. However, the condition can evolve unfavorably, with the progression of the thrombus to the level of the deep venous system, causing deep vein thrombosis and pulmonary embolism. [1][2][3][4] We present the case of a 31-year-old male patient who presented to the emergency room for pain and inflammation in the lower right infragenicular limb, symptoms that appeared 6 days prior. Blood tests showed no significant modification. At the clinical infragenicular examination, an area of inflammation and induration was highlighted on the path of the great saphenous vein. The ultrasound examination revealed local thrombosis of the great saphenous vein as well as the presence of an intravenous body with a posterior acoustic shadowing of approximately 5 mm in diameter (Figure 1).According to the anamnesis, the patient had a minor accident a week earlier in which a metallic body flew and hit the patient at the level of the distal third of the medial face of the right thigh, with no signs of local bleeding, therefore he did not present to the hospital. Due to these findings, to better characterize the type and localization of the foreign body, a computed tomography angiography (CTA) of the lower limbs was performed. The radiological results of the CT were strongly indicative of the presence of a metallic body at the level of the great saphenous vein (Figure 2). Under local anesthesia, exploration of the thrombosed venous segment was performed, with ligation and extraction of the portion of the great saphenous vein that contained the foreign body (Figure 3). During follow-up, the patient was examined at 1 week, 1 month, 3 months, and 6 months after surgery. There were no signs of inflammation or local infection, and the surgical wound had healed.