Arterial ulcers develop due to lack of blood flow to the tissues. They are also known as ischemic wounds or ischemic ulcers. Arterial insufficiency is most commonly associated with atherosclerosis. Buildups of fatty and fibrous deposits slowly clog up the arteries, making the space inside them narrower. This narrowing limits the flow of blood through the arteries. Additionally, when the skin and underlying tissue are deprived of oxygen, the tissue becomes ischemic and forms an open wound. Understanding treatment and prevention measures are crucial for managing this condition.
Physician Assistant Kimmy Nguyen highlights information for a better understanding of these ulcers.
Risk Factors
Those with a history of heart disease, stroke, or other cardiovascular conditions may have a higher risk of developing peripheral artery disease (PAD) and subsequent arterial ulcers. PAD occurs when there is a buildup of fatty deposits in the arteries, leading to reduced blood flow, particularly to the extremities.
The following groups are more susceptible to developing arterial ulcers:
- Elderly Individuals. Aging is a natural factor that can lead to arterial stiffness and reduced blood vessel elasticity, increasing the likelihood of arterial insufficiency and ulcers.
- Smokers. Tobacco use is a major risk factor for PAD and arterial ulcers. Smoking contributes to the narrowing and hardening of arteries, exacerbating the underlying vascular issues.
- High Cholesterol. Elevated levels of cholesterol contribute to the formation of atherosclerotic plaques, narrowing the arteries and impeding blood flow.
- Diabetics. Diabetes is associated with both atherosclerosis and microvascular complications, significantly increasing the risk of PAD. Individuals with diabetes often experience reduced sensation in their extremities, making them more susceptible to injuries and ulcers.
- Hypertension. High blood pressure contributes to the progression of atherosclerosis, putting individuals at a higher risk of arterial ulcers.
- Obesity and Sedentary Lifestyle. Lack of physical activity is a modifiable risk factor for PAD. Regular exercise promotes cardiovascular health and helps prevent the development of arterial ulcers.
Clinical Manifestation
Arterial ulcers exhibit distinct clinical manifestations. The lower extremity may look very slender due to the lack of blook flow to the muscle. Also
- Pain. Arterial ulcers often cause severe pain, especially during periods of rest or at night. Burning or throbbing may describe the pain, and it typically occurs in the affected limb. Exercise brings on pain distal to a narrowed artery in claudication, and rest relieves it. Rest pain often signals severe disease and occurs in the foot when the patient is asleep, relieved by lowering extremity over the side of the bed.
- Wound characteristics. Arterial ulcers commonly occur in the legs and feet which include tips of the toes, corners of nail beds on the toes, over bony prominences and between toes. Wounds usually have well demarcated edges, typically pale and dry.
- Color Changes. The skin color may change to deep bluish red when the patient places their foot in a dependent position.
- Nail Changes. Nail appearances may include their being thin, pale, brittle or crumbly yellow.
Diagnosis
Diagnosing arterial ulcers involves a comprehensive evaluation by a healthcare professional, often starting with a thorough medical history and physical examination. The diagnostic process for arterial ulcers may include a vascular consult. A hand held doppler ultrasound or ankle-brachial index (ABI) can help evaluate the blood flow. Early diagnosis and intervention are key to preventing complications and promoting optimal wound healing.
Treatment
Effective management of arterial ulcers involves a multidisciplinary approach. It is important to reestablish the arterial flow. This could involve medications as well as appropriate wound care and wound protection.
- It is important to keep the wound dry and protected from pressure or trauma. Never soak arterial ulcers.
- If toe wounds are present, apply an antiseptic or antimicrobial agent and then place small gauze pads between the toes. Change the pads daily to keep toe ulcers dry.
- Revascularization procedures, such as angioplasty or bypass surgery, can restore blood flow to the affected area, promoting ulcer healing. If revascularization succeeds, the type of dressing may need to be changed in order to keep moist tissue moist and dry tissue dry.
Prognosis
Due to poor circulation, arterial ulcers may heal slowly over months to years if at all. If left untreated, arterial wounds can lead to infection, tissue necrosis, or even amputation.
Addressing arterial ulcers involves a comprehensive approach encompassing medical intervention, lifestyle adjustments, and preventive measures. Timely and proactive management not only facilitates ulcer healing but also mitigates the risk of recurrence, enhancing the overall quality of life for individuals affected by this condition.
Read additional information on foot and toe ulcers from Cleveland Clinic.