Arterial vs Venous Ulcers
Ulcers are a common problem. Chronic venous leg ulceration affects 35% of patients over 65 year age group at some time and throws enormous on health services in terms of both dressing and staff time. Venous and arterial ulcers are two different entities with regard to causatives, clinical features, and location. This article will talk about both venous ulcer and arterial ulcer in detail, highlighting their clinical features, symptoms, causes, investigation and diagnosis, prognosis, treatment, and finally the differences between venous ulcer and arterial ulcer.
Venous ulcers are due to high blood pressures in the superficial veins. Leakage of blood under high pressure from the deep veins into superficial system, particularly in the region of constantly placed perforators over the medial side of the leg, results in venous dilatation, leathery induration and pigmentation of the skin as a result of stagnation of the circulation and eventually ulceration. It has been suggested that the deposition of fibrin outside the capillose wall and the trapping of white cells in the microcirculation are responsible for impairing the transportation of oxygen and nutrients to the tissues, resulting in the pathological changes found. Patients with venous veins may have a past history of deep vein thrombosis, and they may have visible varicosities of the superficial system. In addition, on investigation, many patients will show to have had a previous unrecognized deep vein thrombosis or venous hypertension owing to deep vein valve incompetence.
Signs of venous ulcers include varicose veins, perforator incompetence, lipodermatosclerosis, and the location of ulcer; over 95% of venous ulcers will be situated in the distal third of the leg on the medial side. Correcting any general disorder, in particular obesity, cardiac failure, anemia, vitamin deficiency, serious debilitating illnesses, appropriate dressing, applying compression bandages, and elevating the limb help venous ulcer healing. Surgical methods like skin grafting, perforator ligation and saphenous ligation can be employed to address the underlying condition.
Arterial ulcers are caused by skin ischemia, usually in association with atherosclerotic peripheral vascular disease. Ulceration occurs normally on the toes, dorsum of the foot, anterior tibial area, or heel and appears as patches of dry gangrene. Buerger’s disease, a disease of men aged between 20 and 40 years, may also be associated with skin gangrene. Small vessel vasculitis may also cause ulceration in patients with rheumatoid arthritis and other collagen disorders.
Arterial insufficiency may be evident from a history of intermittent claudication or rest pain or from the presence of ischemic changes of the limb. Presence of the ulcer suggests severe ischemia; therefore, local treatment of the ulcer is unlikely to be successful unless arterial supply is restored. Pain relief is necessary because pain can be so severe that regular painkillers are needed. Cessation of smoking is essential. Dressing should be simple and dry gangrene area should be exposed. Loose slough has to be cleaned, and pus drained. Direct arterial surgery and lumbar sympathectomy can be used to restore the circulation.
What is the difference between Venous and Arterial Ulcers?
• Arterial ulcers are due to ischemia while venous ulcers are due to stagnation of blood under pressure.
• Arterial ulcers occur on weight bearing points while venous ulcers occur on the medial side of the leg.
• Venous ulcers bleed profusely while arterial ulcers do not.
• Arterial ulcers are painless due to associated neuropathy while venous ulcers are painful.