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
- 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
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"
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.