Introduction. Combat-related injuries to major limb vessels pose a threat to both life and limb. Although clinical management traditionally prioritizes restoration of arterial inflow, the contribution of venous injury to limb ischemia is often underestimated.

Material and methods. We describe the case of a 22-yearold serviceman with multiple blind shrapnel wounds of the right thigh that resulted in grade III acute ischemia of the right lower extremity.

Results and discussion. Intraoperative examination identified a popliteal vein rupture with a 4-cm gap between the stumps, while the popliteal artery remained intact. Autologous venous reconstruction of the popliteal vein was performed using a resected small saphenous vein graft (with a length of 4 cm and a diameter of 1 cm). Within 30 s of restoring venous outflow, pulsation of the popliteal artery and antegrade flow in the tibial arteries were recorded. The procedure was supplemented with a fasciotomy of the lower leg. The postoperative course was uneventful. This case demonstrates that severe impairment of venous drainage, leading to venous hypertension and stasis, may clinically mimic arterial occlusion and present as critical ischemia. Restoration of venous outflow resolved the ischemia without the need for arterial reconstruction.

Conclusion. Isolated popliteal vein injury can lead to critical limb ischemia due to venous congestion.