Arterial insufficiency ulcer

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Arterial insufficiency ulcer
Synonyms	Ischemic ulcer, arterial ulcer
Pronounce	N/A
Specialty	Vascular surgery, Dermatology
Symptoms	Pain, ulceration on lower extremities, pallor
Complications	Infection, gangrene, amputation
Onset	Typically in adults with peripheral artery disease
Duration	Chronic, may persist without treatment
Types	N/A
Causes	Peripheral artery disease, atherosclerosis
Risks	Smoking, diabetes, hypertension, hyperlipidemia
Diagnosis	Ankle-brachial index, Doppler ultrasound, angiography
Differential diagnosis	Venous ulcer, diabetic foot ulcer, pressure ulcer
Prevention	Smoking cessation, exercise, dietary modification
Treatment	Revascularization, wound care, pain management
Medication	N/A
Prognosis	Variable, depends on severity and treatment
Frequency	Common in individuals with peripheral artery disease
Deaths	N/A

Arterial Insufficiency Ulcer

An arterial insufficiency ulcer, also known as an ischemic ulcer, is a type of ulcer that occurs due to inadequate blood supply to the affected area. These ulcers are commonly found on the lower extremities, particularly the feet and toes, and are a result of peripheral artery disease (PAD).

Arterial ulcer peripheral vascular disease

Pathophysiology

Arterial insufficiency ulcers develop when there is a significant reduction in blood flow to the tissues, leading to ischemia. This condition is often caused by atherosclerosis, where plaque builds up in the arteries, narrowing them and reducing blood flow. The lack of adequate oxygen and nutrients results in tissue necrosis and ulceration.

Clinical Presentation

Patients with arterial insufficiency ulcers typically present with:

• Location: Ulcers are usually located on the toes, heels, or lateral malleolus.
• Appearance: The ulcers have a "punched-out" appearance with well-defined edges and a pale or necrotic base.
• Pain: These ulcers are often painful, especially at night or when the legs are elevated.
• Surrounding Skin: The skin around the ulcer may appear shiny, thin, and hairless due to poor circulation.

Two ischaemic ulcers on the foot of an individual with type 2 diabetes

Diagnosis

Diagnosis of arterial insufficiency ulcers involves a thorough clinical examination and may include:

• Ankle-Brachial Index (ABI): A non-invasive test that compares the blood pressure in the ankle with the blood pressure in the arm.
• Doppler Ultrasound: To assess blood flow in the arteries.
• Angiography: To visualize the blood vessels and identify blockages.

Management

The management of arterial insufficiency ulcers focuses on improving blood flow and wound care:

• Revascularization: Procedures such as angioplasty or bypass surgery may be performed to restore blood flow.
• Wound Care: Keeping the ulcer clean and protected to prevent infection.
• Pain Management: Addressing pain with appropriate medications.
• Lifestyle Modifications: Encouraging smoking cessation, exercise, and a healthy diet to improve overall vascular health.

Prevention

Preventive measures include managing risk factors for peripheral artery disease, such as controlling diabetes, hypertension, and hyperlipidemia. Regular foot care and monitoring are essential for individuals at risk.

See also

• Peripheral artery disease
• Atherosclerosis
• Ulcer (dermatology)
• Diabetic foot

Comparison of apples and oranges

See Also

• Venous ulcer
• Diabetic ulcer