Arterial Disease Ulcers, Part 1

Abstract

Arterial disease (peripheral vascular disease) is the result of narrowing of the blood vessel lumen. The classic clinical signs need to be recognized early before progression to arterial predominant disease and limb ischemia. Arterial ulcers or tissue breakdown can result from trauma, infection, or other etiologies with diabetes, smoking, increasing age, and hypertension the most important risk factors. Diagnostic testing starts with a palpable pulse with special investigation including handheld Doppler for ankle brachial pressure index ratios, segmental duplex leg Doppler waveforms, and more specialized procedures, including transcutaneous oxygen saturation.

Arterial hand ulcer: A common disease in an uncommon location

“…All of these features were present in our patient (Fig 1). The area around the wound may be cool, with diminished or absent pulses, and bilateral blood pressure measurements may be asymmetric 4 . Pain can be striking, as in our patient, and is often described as sharp as opposed to throbbing, burning, and itching with venous ulcers, 5 which are often considered alongside arterial insufficiency.…”

“…This would have uncovered the right upper limb deficit, leading to a timelier diagnosis. Once diagnosed, vascular surgery can provide definitive treatment, as shown here 4 …”

“…Peripheral arterial disease alone is generally insufficient to cause or sustain ulceration of the hands 4 . Although arterial insufficiency limits blood flow, it generally is adequate to maintain skin integrity but will be insufficient to support repair after another inciting factor, such as physical trauma 4 .…”

“…Peripheral arterial disease alone is generally insufficient to cause or sustain ulceration of the hands 4 . Although arterial insufficiency limits blood flow, it generally is adequate to maintain skin integrity but will be insufficient to support repair after another inciting factor, such as physical trauma 4 . We believe that, in our patient, the minor injury to his right hand in the setting of arterial insufficiency from previous surgical fixation of a clavicle fracture and unrecognized atherosclerotic disease led to poor healing and, ultimately, chronic ulceration.…”

Venous, Arterial, and Neuropathic Leg Ulcers With Emphasis on the Geriatric Population

“…Its most common predisposing condition is an advanced peripheral vascular disease affecting lower extremity arteries that supply the leg and foot [30]. Other risk factors include atherosclerosis, hypertension, diabetes, and atrial fibrillation, all of which are more prevalent in the geriatric population [31]. Arterial ulcers are commonly located on the leg or foot area but have features quite distinct from VLU with an illustration of an arterial ischemic ulcer in Figure 5.…”