What is an Arterial Ulcer?

Arterial ulcers are also referred to as ischemic ulcers. They are the result of poor perfusion (delivery of nutrient-rich blood) to the lower extremities. The overlying skin and tissues have been deprived of oxygen. Thus, killing these tissues and causing the area to form an open wound. In addition, the lack of blood supply can result in minor scrapes or cuts failing to heal. These can eventually develop into ulcers.

The arteries are responsible for carrying nutrient- and oxygen-rich blood to the various tissues in the body. Ischemia refers to a restriction in the blood supply. This can lead to arterial ulcers when it stems from a narrowing of the artery or damage to the small blood vessels in the extremities. The reduced blood flow then in turn leads to tissue necrosis and/or ulceration.

Symptoms of Arterial Ulcers

Arterial ulcers are characterized by a punched-out look is usually round in shape, with well-defined, even wound margins. Arterial ulcers are often found between or on the tips of the toes, on the outer ankle, or where there is pressure from walking or footwear. The wounds themselves are characteristically deep, often extending down to the underlying tendons, and will frequently display no signs of new tissue growth. The base of the wound typically does not bleed, and is yellow, brown, grey or black in color.

Often the limb will feel cool or cold to the touch, and the extremity will have little to no distinguishable pulse. The skin and the nails on the extremity will also appear atrophic, with hair loss on the affected extremity, while also taking on a shiny, thin, dry, and taut appearance. In addition, the base color of the extremity may turn red when dangled and pale when elevated. An additional sign of an arterial ulcer is delayed capillary return in the affected extremity.

These ulcers are generally very painful, especially while exercising, at rest, or during the night. A common source of temporary relief from this pain is dangling the affected legs over the edge of bed, allowing gravity to aid blood flow to the ulcerous region.

“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

A number of risk factors may contribute to the development of an arterial ulcer including the following comorbidities and conditions:

• Diabetes
• Foot deformity and callus formation resulting in focal areas of high pressure
• Poor footwear that inadequately protects against high pressure and shear
• Obesity
• Absence of protective sensation due to peripheral neuropathy
• Limited joint mobility

Treatment for Arterial Ulcers

Without treatment of the underlying poor arterial blood supply, ulcers take a long time to heal or may never heal. These ulcers are treated by covering them with dressings or using creams or ointments, or both to promote healing and protect the ulcers from infection.

In order to salvage the limbs, Arterial Ulcers as well as PAD is medically treated. These medications treat high cholesterol, control blood pressure. As well as, decrease pain while walking in order to increase exercise. They also aim to prevent the buildup of plaque or formation of blood clots.

Minimally invasive interventional radiology procedures can be a treatment for peripheral artery disease . Angioplasty is opening a blocked artery with a medical balloon, enabling better blood flow. In some cases, the affected arteries need to remain open using a stent, which is a small metal cylinder. This treatment is stenting.

A stent-graft is another procedure. This is when a stent covered with a synthetic fabric is placed in the blood vessels to bypass affected arteries. A third interventional radiology procedure for peripheral artery disease called atherectomy. This procedure uses small catheter at the site of the blockage in order to shave the plaque away from the inside of the artery and remove it from the patient’s body

In some cases,peripheral arterial diseasemay be serious enough that a medical team has no choice but to perform surgery. This may be the only way to remove blockages or create bypasses around the clogged areas.