Arterial Ulcers: Everything You Need to Know

Arterial Ulcers, also known as ischemic ulcers, occur as a result of poor perfusion—delivery of oxygen and nutrient-rich blood—to the lower extremities. This lack of adequate blood flow causes the overlying skin and tissues to be oxygen-deprived, leading to tissue death and the formation of open wounds.

Symptoms of Arterial Ulcers

Arterial ulcers possess characteristic features. They usually appear round, with a punched-out look and well-defined, even wound margins. Notably, they are often found between or on the tips of the toes, on the outer ankle, or anywhere pressure results from walking or footwear. These ulcers are deep, often reaching down to the underlying tendons and hindering signs of new tissue growth. The base of the wound typically does not bleed and may appear yellow, brown, grey, or black. In addition, the limb affected often feels cool or cold to the touch, with a barely detectable pulse. Skin and nails on the extremity may appear atrophic, characterized by hair loss on the affected part, a shiny, thin, dry, and taut appearance. There may be a shift in the base color of the extremity, turning red when dangled and pale when elevated. A delayed capillary return in the affected extremity further signals an arterial ulcer’s presence. Patients generally experience considerable pain with these ulcers. Particularly while exercising, resting, or during the night. Alleviation of this pain can happen by dangling the affected limbs over the edge of the bed. This enables gravity to assist blood flow to the ulcerous area.

“An ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin. In most people, such an injury will heal without difficulty within a week or two. However, when there is an underlying problem, the skin does not heal, and the area of breakdown can increase in size. This is a chronic ulcer. If the reason for the ulcer not healing is poor circulation due to blocked arteries in the leg (atherosclerosis) we call it an ARTERIAL ULCER.” 

Risk Factors

Several comorbidities and conditions may contribute to the development of an arterial ulcer, such as:

• Diabetes
• Foot deformities and callus formations leading to high-pressure
• Inadequate footwear offering insufficient protection against high pressure and shear
• Obesity
• Absence of protective sensation due to peripheral neuropathy
• Limited joint mobility

Treatment for Arterial Ulcers

At Coastal Vascular Center, we understand the necessity of treating the root cause—poor arterial blood supply. Without addressing it, ulcers may take an extended period to heal or may never heal at all. Arterial ulcers at Coastal Vascular Center are treated using medical dressings, creams, and ointments to stimulate healing and protect the ulcer from infection. Simultaneously, we are dedicated to conserving the limbs by treating arterial ulcers and Peripheral Arterial Disease (PAD) medically. Medications are used to manage high cholesterol, control blood pressure, reduce walking pain, and prevent the buildup of plaque or the formation of blood clots. We also employ minimally invasive interventional radiology procedures, such as angioplasty for the treatment of peripheral artery disease, which involves unblocking the arteries using a medical balloon to promote better blood flow. In other instances, arteries are kept open using a stent—a small metal cylinder. This involves placing a stent in the arteries or veins to keep them open and blood flowing. We also utilize atherectomy, which involves shaving plaque from the inside of the artery using a small catheter at the site of the blockage and removing it from the patient’s body. In severe cases of peripheral arterial disease, our team will work with you to provide the best treatment. This may mean performing surgery to remove blockages or create bypasses around the clogged areas. Understanding the severity of arterial ulcers and the need for specialized care is essential. If you or a loved one is experiencing any symptoms described above, please get in touch with Coastal Vascular Center today.