Why Arterial Ulcers Are The Most Common Complication of Peripheral Arterial Disease

Arterial ulcers, also known as ischaemic ulcers or ischaemic wounds (ischaemia = lack of oxygen and nutrients in the affected cells of a specific tissue), are deep skin injuries brought about by the impaired and reduced supply of arterial blood into the lower limbs. Due to the restricted blood supply possibly resulting from arterial narrowing, arterial obstruction (due to a clot or embolism, i.e. a clot travelling with blood and blocking the vessel) or small vessels in the limbs, skin and other tissues of the affected area have less oxygen and nutrients available. Such deficit may lead to tissue degeneration and the development of cracks and wounds that cannot heal and thus slowly progress to an ischaemic ulcer.

Arterial ulcers are the most common complication of peripheral arterial disease (PAD), which is usually a consequence of the atherosclerotic narrowing of the medium-size and large arteries of the upper and lower extremities (atherosclerosis = cholesterol accumulation in blood vessel walls). The disease is most common in men (above the age of 45) and women (above 55) with previous problems due to cardiovascular complications. The development of PAD and arterial ulcers is influenced by smoking, obesity and increased blood fat levels, while other common causes of ulcers include type 2 diabetes, increased blood pressure, vasculitis (i.e. blood vessel wall inflammation), and kidney failure.

Arterial ulcers are the most common complication of peripheral arterial disease (PAD), which is usually a consequence of the atherosclerotic narrowing of the medium-size and large arteries of the upper and lower extremities (atherosclerosis = cholesterol accumulation in blood vessel walls). The disease is most common in men (above the age of 45) and women (above 55) with previous problems due to cardiovascular complications. The development of PAD and arterial ulcers is influenced by smoking, obesity and increased blood fat levels, while other common causes of ulcers include type 2 diabetes, increased blood pressure, vasculitis (i.e. blood vessel wall inflammation), and kidney failure.

Increased risk for arterial ulcers can be seen in people with little or no distinguishable pulse on the upper foot and behind the back side of the inner ankle. The so-called Buerger test can also be used to diagnose lower limb ischaemia. The patient’s leg should be raised in the air for one minute at an angle of 45 degrees so that it becomes slightly pale. If, after lowering the leg, the skin turns pink only after more than 15 seconds, this may indicate impaired blood supply to the lowered leg.

Increased risk for arterial ulcers can be seen in people with little or no distinguishable pulse on the upper foot and behind the back side of the inner ankle. The so-called Buerger test can also be used to diagnose lower limb ischaemia. The patient’s leg should be raised in the air for one minute at an angle of 45 degrees so that it becomes slightly pale. If, after lowering the leg, the skin turns pink only after more than 15 seconds, this may indicate impaired blood supply to the lowered leg.

Arterial ulcers can be chronic, or they can develop de novo, representing a large burden for both the patient and the healthcare system. When such wounds are not treated, a severe infection might develop, ultimately possibly requiring amputation of the affected limb.


Sources:

Wound Source. Arterial Ulcers. (Available at: https://www.woundsource.com/patientcondition/arterial-ulcers)

Medscape. Vascular Ulcers (Available at: https://emedicine.medscape.com/article/1298345-overview#showall

Amboss. Peripheral arterial disease. (Available after registration at: https://next.amboss.com/us/article/ch0a1f#Zca04f2e66d13ff93d2dfe26c676931d8)

Grey, Joseph E, et al. “Venous and Arterial Leg Ulcers.” BMJ (Clinical Research Ed.), BMJ Publishing Group Ltd., 11 Feb. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1363917/. 

Košnik, Mitja, et al. Interna Medicina. Medicinska fakulteta, 2018.

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