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Arterial Ulcer - Causes, Symptoms, and Treatment

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Arterial ulcers are painful ulcers formed on the skin of extremities such as feet and legs due to poor blood supply. Read the article to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At December 20, 2022
Reviewed AtJune 21, 2023

Introduction

Arterial ulcers or ischemic ulcers (ischemia means less blood flow) are formed by reduced blood flow to the peripheral areas of the body. Since the blood flow is poor, the oxygen supply to these areas is also reduced, which leads to ulceration and, ultimately, the death of the tissue.

What Is an Arterial Ulcer?

Arteries are blood vessels that carry blood products and oxygen to various body parts. When arteries are narrowed, the blood supply gets restricted, and the skin and tissues of that area are deprived of oxygen. The arterial ulcer usually occurs on the ankles or the toes.

What Are the Causes of Arterial Ulcers?

The causes include:

  • Ischemia due to peripheral vascular disease (a disease affecting the blood vessels and causing their narrowing).

  • Vasculitis (inflammation of the blood vessels).

  • Diabetes mellitus.

  • Hypertension (increased blood pressure).

  • Arteriosclerosis (blockage of arteries).

  • Atherosclerosis (a type of arteriosclerosis causing blocked arteries due to fat buildup).

  • Smoking.

  • Kidney failure.

  • Older adults.

  • Trauma.

  • Any condition causing restricted movement of the legs.

What Are the Symptoms of Arterial Ulcers?

The arterial ulcers are mostly found on the outer aspect of the feet, ankles, heels, and toes. They have a characteristic ‘punched out’ appearance. They are deep ulcers, often involving the underlying tendons and not showing any signs of bleeding.

The changes observed are:

  • The pain usually occurs at night or while exercising.

  • Intermittent claudication (pain on walking).

  • The color changes to yellow, brown, gray, or black.

  • The affected area becomes hairless.

  • Nails become atrophic (partial or complete loss of the nail) and darkened.

  • Skin becomes dry, thin, and shiny.

  • The foot changes to red color while hung down and turns pale when elevated.

  • The temperature of the affected area drops down due to the restricted blood supply. It is cold to touch.

  • The pulse is not felt in the affected area.

Who Are More Likely to Get Arterial Ulcers?

There are a variety of conditions that increase the risk of developing arterial ulcers. People with the following conditions are more likely to get arterial ulcers:

  • Overweight.

  • Diabetes mellitus.

  • Conditions causing limited movement to the legs.

  • Smokers.

  • Areas with callus formation due to increased pressure.

  • Uncomfortable or ill-fitting footwear that causes more stress on the feet.

  • Any condition that limits the blood supply to the feet.

What Are the Diagnostic Aids Available for an Arterial Ulcer?

The diagnosis of an arterial ulcer is usually made by clinical examination and using certain bedside tests.

They are:

Capillary Refill Time - This is not a specific test to find the amount of blood flow. The time taken for the blood vessels to refill following its compression is measured. If it takes longer to refill, it indicates inadequate blood flow.

Buerger Test - The patient is made to lie down and lift their leg at a 45-degree angle to the floor. If the foot becomes pale upon elevating and bright red on lowering, it indicates insufficient blood flow.

Ankle-Brachial Index - It is the ratio of the highest blood pressure at the ankle to the arm. A value of less than 0.9 indicates arterial insufficiency.

Toe Brachial Index - It calculates the highest right or left toe blood pressure ratio to the highest pressure of the arms. This index measures the amount of blood supply in that area.

Transcutaneous Oximetry - It measures the oxygen content of the skin around the wound. Values less than 40 mmHg indicate arterial insufficiency.

What Are the Treatment Options for an Arterial Ulcer?

The treatment of an arterial ulcer aims to improve the blood supply and promote the healing of the ulcer.

Medications - The underlying medical conditions are first treated to prevent the cause of arterial insufficiency. Hypertension (high blood pressure), diabetes, and cholesterol levels are brought to normal levels by prescribing appropriate medications.

Angioplasty - Angioplasty is a procedure wherein a balloon catheter (a long tube) is inserted into the blood vessel and unclogs the blocked or narrowed artery.

Stenting - A tube inserted into the blood vessel that has been opened and prevents it from narrowing again.

Atherectomy - It has a catheter with a blade at one end. The catheter is inserted into the blood vessel, and the blade removes the plaque inside the artery. This procedure is done when the other two treatments fail to heal the blood vessel.

All the Procedures have a Common Goal: Remove any blocks in the artery so that it can function normally for good blood flow to the area of the arterial ulcer.

How to Take Care of the Wound?

The following are the instructions for proper wound care after the surgery.

  • The dressing for the wound must be changed regularly by themselves or by the caretaker.

  • The wound is kept clean and covered with a bandage.

  • The area around the wound should be dry. If the surrounding area is wet, the wound infection can spread and become more extensive.

What Are the Complications of an Arterial Ulcer?

The complications occur if the arterial ulcer is unnoticed and is left untreated for a long time. Tissue necrosis (death of the tissue) or amputation (removal of a part of the feet) can occur when the infection becomes more extensive. Hence, the patient must consult the doctor immediately to prevent such circumstances.

How to Prevent an Arterial Ulcer?

The following precautions are followed to prevent the risk of developing an arterial ulcer or minimize the complications.

  • The patient has to maintain blood pressure, blood sugar, and cholesterol levels.

  • Patients with smoking habits must quit.

  • The feet are examined regularly for any changes in color or the presence of an ulcer.

  • Avoid wearing ill-fitting footwear and tight elastic socks.

  • The patient must avoid standing for a long time.

  • Try to protect feet from the cold.

  • Soaking the feet in warm water is usually avoided.

  • Avoid sitting with the legs crossed.

  • Wash the feet properly to prevent any infection.

  • Exercises are performed every day as per the physician's recommendation to increase blood flow.

Conclusion

Arterial ulcers are formed in areas of poor blood supply. Hence, re-establishing the blood flow through various treatment modalities remains the mainstay of the treatment. With adequate blood flow, arterial ulcers usually heal unless there are any associated complications.

Frequently Asked Questions

1.

Does the Arterial Ulcer Appear Wet or Dry?

The ulcer appears punched out, which is small, round, and smooth with a well-defined border. The ulcer caused may be shallow or deep. The ulcer is pale, dry, necrotic, and without granulation tissue.

2.

How Is Arterial Ulcer Described?

Arterial ulcers are a form of open sore seen on the body, which usually occurs in the lower extremities. These occur due to damage to arteries. They are red, yellow, or red sores with deep wounds. They are usually small, round, pale, and dry with well-defined borders.

3.

How Is the Dressing of Arterial Ulcer Done?

This ulcer will have reduced exudate, and the skin surrounding the ulcer will be fragile. So moist, non-adherent dressing is required. Arterial ulcers are prone to bacterial contamination; the dressing should be done with antimicrobial properties for better induction control.

4.

What Is the Diagnosis Method for Arterial Ulcers?

Before any treatment, the underlying cause of the ulcer should be identified. The ulcer can be treated with antibiotics and good care, but only diagnosing the underlying cause can cure the ulcer. Some of the conditions that cause ulcers are:
 a) Diabetics.
 b) Deep vein thrombosis.
 c) Rheumatoid arthritis.
 d) Arterial disease.
 e) Lupus.
 f) Chronic kidney disease.
 g) High blood pressure.
 h) High cholestrol.

5.

Are Arterial Ulcers Elevated?

Arterial ulcers are small, round, and smooth with well-defined borders. The wound caused may be deep or shallow. Arterial ulcers, when elevated, turn pale.

6.

How Is This Ulcer Cleaned?

A cleaning solution can be used with the help of a swab or a syringe with a needle. A cleaning solution can be used to bathe the ulcer wound using a bucket or basin. Cleaning can be painful and can cause discomfort.

7.

How Are Arterial Ulcers Coded?

The arterial ulcer should be coded either with 170.23- (Atherosclerosis of native arteries of the right leg with ulceration)/ or 170.24- (Atherosclerosis of native arteries of the left leg with ulceration).

8.

Does Arterial Ulcers Bleed?

The base of the ulcer wound, which is yellow, brown, black, or grey in color does not bleed. The Limb will be cold, and the extremities will have minimal or no pulse.

9.

How Do Arterial Ulcers Occur?

Arterial ulcers are caused due to decreased arterial blood supply to the lower limbs. The most common condition which causes arterial ulcers is atherosclerotic disease of the arteries. Poor blood circulation is the primary cause of these ulcers.

10.

Does Arterial Ulcer Cause Pain?

Arterial ulcers are most often painful; they usually occur on the foot, around the ankle, and lower leg. The pain can be aggravated during the night. People hang their legs affected with arterial ulcers out of bed or sleep in a chair to relieve the pain during the night. Adequate analgesics are required to manage the pain.

11.

How Does an Arterial Ulcer Heal?

An arterial ulcer is an Ischemic ulcer or wound caused by damage to the artery and reduced blood flow to the tissues. These are not like other ulcers; the leg ulcer wound may take months to heal. The primary concern is to relieve the patient from the pain, as these ulcers cause severe pain. Treatment includes increasing the blood flow to the affected area.

12.

How Is Arterial Ulcer Identified?

These ulcers usually occur on the outer side of the ankle, feet, heel, or toes. Arterial ulcers are:
 - Red, yellow, or black sore.
 - Deep wound.
 - Tight and hairless skin.
 - Severe leg pain at night.
 - No bleeding.
 - The affected area will be cool to the touch with reduced blood flow.
 - Leg turns pale when elevated.

13.

How Is Arterial Ulcer Treated?

The treatment of arterial ulcers includes restoring blood to the affected area. Use of antibiotics in order to treat the underlying condition, but this will not heal the ulcer completely. The doctors recommend surgery to retain blood flow to the tissues and organs along with antibiotics.
Source Article IclonSourcesSource Article Arrow
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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