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Arterial ulcer

What is a arterial ulcer?

An ulcer is a full-thickness area of skin breakdown. An arterial ulcer is an ulcer due to inadequate blood supply to the affected area (ischemia) Arterial ulcers tend to occur in the lower legs and feet, and can be acute, recurrent or chronic. Ulcers can have multiple contributing factors; These "mixed ulcers" make up approximately 15% of all leg ulcers.

An arterial ulcer is also known as ischemic ulcer (an ischemic ulcer, using American spelling).

Who Gets Arterial Ulcers?

Certain lifestyle factors and medical conditions have been associated with the development of arterial ulcers. These include:

  • Diabetes
  • Of smoking
  • High fat content in the blood and cholesterol
  • Hypertension
  • Renal failure
  • Obesity
  • Rheumatoid arthritis
  • Coagulation and circulation disorders.
  • Other arterial diseases, such as heart disease, cerebrovascular disease and peripheral vascular disease.

What Causes Arterial Ulcers?

Arterial ulcers are caused by arterial insufficiency; that is, inadequate supply of oxygen and nutrient-rich blood to the tissues. Arterial insufficiency is caused by high blood pressure and narrowing of the arteries due to atherosclerosis. Atherosclerosis is due to circulating deposits lipids at the sites of the vessel walls damaged as a result of the effects of smoking and high blood pressure. These deposits partially occlude the artery, resulting in reduced blood flow to the tissues.

  • In most cases, an arterial ulcer develops after a minor injury that is slow to heal due to poor blood supply to the wound.
  • In severe arterial disease, spontaneous cell death can cause skin breakdown without a rushing injury.
  • Alternatively, cholesterol deposits lining the blood vessel walls can break and lodge in smaller vessels downstream, causing a sudden and complete blockage in flow; this process is called embolic occlusion.

What are the clinical features of arterial ulcers?

The hallmarks of arterial ulcers include:

  • Located on the lower legs and the upper part of the feet or toes
  • A tendency to be painful, particularly at night.
  • A symmetrical shape with well defined edges, often described as having a "perforated appearance"
  • Minimal bleeding when touched or struck
  • Cold, pale, or bluish surrounding skin that appears shiny
  • Loss of leg hair
  • Weak or absent ankle pulses.

Other symptoms of arterial insufficiency may also be present, such as:

  • Cramping pains in the buttocks and back of the legs during exercise, relieved by rest (intermittent claudication); This is due to insufficient oxygen supply to meet the increased muscle exercise needs.
  • Burning pain in the leg or foot at rest, which is relieved by lowering the foot and worse by raising it.

How are arterial ulcers diagnosed?

The underlying cause of a leg ulcer is diagnosed through a complete patient history and careful examination. Bedside tests include:

  • Capillary reload time: this is the time it takes in seconds for small blood vessels on the surface of the skin (eg, on the toe) to fill with blood after they are compressed. A prolonged capillary refill time may indicate arterial insufficiency in a patient with a lower extremity ulcer, but is not specific. sign.
  • A Buerger test: This involves having the patient lie down and raise the leg 45 degrees above horizontal for 1 minute. A positive test that suggests arterial disease is marked by the patient's foot that turns pale when raised and then turns bright red when lowered under the bed.
  • Ankle-Brachial Pressure Index (ABPI) - This is where a Doppler probe is used to measure blood pressure in both the ankle and the arm. If the proportion of these two values is <0.9, es probable que se presente enfermedad arterial. Un valor de ≤ 0.5 sugiere enfermedad grave.
  • Transcutaneous oximetry - This is a measure of the oxygen content of the skin around a wound. The measures <40 mmHg indican insuficiencia vascular y <20 mmHg indican insuficiencia severa.

Which is the differential diagnosis of an arterial ulcer?

The differential diagnosis of a leg ulcer includes venous disease, diabetes, pressure injury, skin Cancer and rare causes, such as vasculitis and pyoderma gangrenous

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What is the treatment for arterial ulcers?

Treatment for arterial ulcers involves addressing the relevant factors that contribute to arterial insufficiency and the subsequent development of ulcers in an individual. This can involve:

  • Lifestyle changes, such as quitting smoking and changing your diet to reduce blood. lipid and cholesterol levels or control blood glucose
  • Wound care: keep the ulcer clean and moist by regularly changing wound dressings and chemical or physical ones debridement (removal of areas of dead tissue)

  • Wound treatment infection - It should be noted that although bacteria colonize almost all leg ulcers, systemic Antibiotics are not required unless there are clinical signs of infection.

Signs that a venous ulcer may require antibiotic treatment include:

  • Redness and swelling of the surrounding skin.
  • Increasing heat
  • Increasing pain
  • Increase in the size of the wound.
  • Growing download wound, especially pus
  • Fever.

Current Topical antiseptics and antibiotics have been shown to decrease the rate of wound healing despite their bactericide properties and are not recommended.

Surgical intervention

An arterial ulcer can be repaired using a skin graft (where a thin piece of skin is removed from another site, usually the upper thigh, and placed over the wound). A skin flap is an alternative way to cover the wound.

Surgical revascularization of a limb aims to restore blood flow by either avoiding or angioplasty (reopening) of narrow vessels. This improves the healing of an ischemic ulcer by restoring the supply of oxygen and nutrients to the tissue.