An arterial ulcer is also known as ischemic ulcer. It occurs as a result of insufficient blood supply to the lower parts of the leg. Damaged or blocked arteries can also lead to arterial ulcer. The arteries are unable to transfer nutrient-rich blood and oxygen to the tissues at the lower leg region.
When blood does not flow to the lower part of the leg, the skin and underlying tissues die off due to lack of nutrient and oxygen. The skin at the affected area then cracks and open up, forming open wounds.
It mostly occurs at the lower leg region, on the surface of the ankle and toes. Arterial ulcers could be acute or chronic. It could take months before they heal.
Causes of Arterial Ulcer
Damaged or blocked arteries are the common causes of arterial ulcers. Some other related medical conditions and factors could lead to an arterial ulcer. These include:
- Diabetes
- High blood pressure
- Kidney failure
- Aging
- Smoking
- Trauma
- Vasculitis
- High cholesterol
- Atherosclerosis (thickening of the arteries)
- Arteriosclerosis (hardening of the arteries)
- Peripheral vascular disease
- Renal failure
- Limited joint mobility
Risk factors of developing Arterial Ulcer
Risk factors may be human factors or medical factors that can increase the chances of developing arterial ulcer.
The risk factors include:
- Individual’s that are overweight have an increased rate of developing arterial ulcer
- Individual’s with diabetes
- Extremely tight or improper footwear
- Foot deformity and callus formation
- Lack of mobility
- Peripheral neuropathy (lack of sensation)
Symptoms of Arterial Ulcer
The symptoms or signs of arterial ulcer include:
- The skin at the affected area begins to turn reddish
- Hardened skin at the affected area
- Swollen ankles
- Aching and swollen legs
- Itching and pains
- Thickened skin
- Worsening pain in your legs when at rest or at night
- Foul and unpleasant smell emitting from the ulcer
- Unpleasant discharges coming out from the ulcer.
- Feeling of cold at your lower legs or feet
- Hair loss at the affected area
Diagnosis of Arterial Ulcer
During the diagnosis of arterial ulcer, your doctor will ask you a series of questions about your medical history. The skin of the affected area will be examined and some tests will be conducted on you.
You may need to undergo tests such as:
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Buerger test
This is a test done to know if a patient actually has arterial disease or not. During the test, you will need to lie down flat and raise your legs at 45 degrees above horizontal for about one minute. If your foot turns pale when it is elevated and turns red when lowered, then it suggests that you have arterial disease.
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Capillary refill time
This is a test done to determine arterial insufficiency in a patient. It is the time it takes for small blood vessels in the skin surface to be filled with blood after they are compressed. If it takes a longer time, then it suggests that you may have arterial insufficiency.
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Transcutaneous oximetry
This is a measurement taken to determine the amount of oxygen in a wound. It is used to determine vascular insufficiency or severe insufficiency. If the amount of oxygen is less than 40 mmHg, it indicates that you have vascular insufficiency. If the oxygen content is less than 20 mmHg, it indicates that you have severe insufficiency.
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Ankle Brachial Pressure Index (ABPI)
This is the measurement of blood pressure. A Doppler probe is used to measure the blood pressure to indicate the severity of the disease. If your blood pressure is less than 0.9, it indicates that you are likely to have arterial disease. If your blood pressure is 0.5 or less, it indicates that you have a severe arterial disease.
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Imaging scans
You may also need to undergo imaging scans such as x-rays, MRI, and CT scan so that your doctor can have a clearer view of the internal tissues of your legs and bones. It will also help your doctor to know if the disease has affected the bones in your feet.
Treatment of Arterial Ulcer
Arterial ulcer can be treated with home remedy measures or self-care. These measures can also prevent you from developing arterial ulcer.
You will need to undergo medical care and treatments when you are already diagnosed with arterial ulcer.
Self-care remedies for arterial ulcer include:
- Stop smoking
- Avoid wearing very tight shoes or improper shoes
- Always examine your feet for unusual signs or changes.
- Avoid crossing your legs while sitting. Always place your both legs on the floor to enhance blood circulation.
- Protect your legs and feet from injuries and infections by always wearing footwear.
- Avoid extreme cold temperatures
- Manage your blood pressure, blood sugar level, and cholesterol level.
If you already have arterial ulcer, you need to see a qualified doctor for treatment.
The treatment options may depend on the severity and stage of the ulcer. Treatment includes:
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Debridement
Your doctor will first need to evacuate all dead tissues from the surface of the wound. After which, the wound will be gently and thoroughly cleaned. Necessary medications such as iodine and topical antibiotic ointment may be applied to the wound and then bandaged properly. The bandage needs to be changed periodically and the wound re-cleaned. The rate at which the wound is healing will determine how often the bandage needs to be changed.
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Improving or restoring blood circulation
Lack of blood to the affected area is what leads to arterial ulcer. Your doctor will as much as possible try to restore or improve blood flow to the affected area. Surgical procedures may also be used to restore blood flow to the affected area. When the blood is restored to the affected areas, you will begin to experience great improvement and healing.
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Amputation
Amputation is the last resort when all other methods of treatments have been used but the wound is not healing or improving. When the wound is not healing, it gets infected and the infection can transfer to other areas.
To prevent the infection from being transferred to other parts of your body, your doctor may have to cut off the affect leg or feet.
