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Arterial Ulcers

Complete or partial arterial blockage may lead to tissue necrosis and / or ulceration. Signs on the extremity that one should look for include:

  • Pulselessness of the extremity
  • Painful ulceration
  • Small, punctate ulcers that are usually well circumscribed
  • Cool or Cold skin
  • Delayed capillary return time (briefly push on the end of the toe and release, normal color should return to the toe in 3 seconds or less)
  • Atrophic appearing skin (shiny, thin, dry)
  • Loss of digital and pedal hair
  • Can occur anywhere, but is frequently seen on the dorsum (top) of the foot.

Utilize noninvasive vascular tests such as doppler, waveform, Ankle Brachial Indices (ABI) and Transcutaneous Oxygen Pressure measurements (TCPO2) to aid in your diagnosis. Duplex scanning and arteriograms may also be performed if indicated.

Large vessel disease must be differentiated from small vessel disease. A blockage in a large artery may be removed or bypassed. Narrowing of smaller arterial vessels is more difficult to address.

Treatment: Treatment of an arterial ulcer has many goals. The primary goal is to increase the circulation to the area in question. This can be done surgically or medically (with oral pills) depending on the cause of the ulcer and the patient's overall medical condition.

Many clinicians like the keep an arterial wound somewhat dry, as they have found that too much moisture can lead to problems. Usually, topical treatment is very conservative.

Some people have wondered if applying topical nitroglycerin paste would help increase local blood flow. An article by Kim, Ballinger and Kushner in the July/August 2006 issue of the AMPA Journal says, "a nitroglycerin patch dose of 0.2 mg/h showed no measurable ability to increase perfusion to the foot"

Picture of arterial ulcer

Note how this patient has arterial ulcers on the lateral malleolus and dorsum of the near foot as well as the medial malleolus of the far foot.


Authored by Dr. Allan D. Freedline and Dr. Tamara D. Fishman.

 


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