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Arterial and Venous Ulcers: What is the Difference?

Author: Lien Pham

Venous and arterial ulcers commonly appear as open wounds in your lower legs and feet. Understand how treatment can differ depending on your symptoms.

An ulcer is a breakage in the skin of the leg, allowing bacteria to reach the soft tissues. There are various types of ulcers such as bedsores, peptic ulcers, mouth ulcers, arterial, and venous ulcers. While ulceration is common among seniors (above 60 years of age), it affects all age groups.

Ulcerations in the lower limbs are of two types – arterial or venous ulcers. Since the pathophysiology in both these ulcers differs, they require different treatments and management approaches. Sometimes, arterial and venous ulcers take months or years to heal, if they heal at all. For healthcare professionals, accurate and timely diagnosis is the foundation of ulcer care.

What are arterial ulcers?

Arteries carry oxygen and nutrient-rich blood to various parts of the body. Arterial ulcers (also known as ischemic ulcers) occur when there is poor circulation (perfusion) to the lower parts of the body (legs and feet).

The overlying tissues do not receive oxygen, and over time, this results in an open wound. Eventually, this develops into an arterial ulcer.

Treatment for arterial ulcers ranges from antibiotics, restoring blood supply to the legs, regularly checking the wound, to dressings for arterial ulcers. If not treated in a timely and efficient manner, medical complications may occur.

Causes of arterial ulcers

Blocked arteries or atherosclerotic disease of the large arteries (thickening or hardening due to plaque) is the primary cause of arterial ulcers.

Poor oxygen and nutrient circulation to the lower extremities lead to open wounds, resulting from inflammation.

Some of the most common risk factors include diabetes, poor deformity, obesity, smoking, and a lack of proper footwear.

Some of the most common causes of arterial ulcers are:

  • Poor circulation: The primary reason behind arterial ulcers
  • Arteriosclerosis or atherosclerosis: Thickening of the arteries due to plaque build-up
  • Venous insufficiency: Blood from the veins in the leg does not go back to the heart
  • Diabetes: A diabetic foot often results in sores and ulcers
  • Kidney failure: Chronic kidney conditions or renal failure result in arterial ulcers.
  • Hypertension: Uncontrolled blood pressure results in lower blood supply to the legs
  • Lying in one position for too long: Lack of body movement and sitting in the same position for long hours also leads to arterial ulcers.

What are venous ulcers?

Venous ulcers are the most common type of foot ulcers. They form due to poor blood circulation to the lower parts of the body. Usually seen around the ankles, venous ulcers require timely and accurate medical management. Lack of treatment may result in further complications.

People with a history of varicose veins, hypertension, obesity, smoking, old age, and a history of venous insufficiency are more prone to this condition. Medical providers usually recommend compression wraps, exercising, regular examining the wound, and dressings to treat this condition.

Causes of venous ulcers

A venous ulcer is simply skin breakage due to poor blood supply. When the veins in the leg do not pump blood back to the heart, high blood pressure prevails in the lower part of the limbs. The backward blood flow makes the veins scarred, weakening the skin around it and disrupting any healing process. Cuts and wounds sometimes take too long to heal or do not heal at all.

Venous ulcers are also caused due to:

  • Varicose veins: Large, bulging, and visible veins occur due to poor blood circulation. Therefore, a pool of blood collects in the lower limbs.
  • Chronic venous insufficiency: When the veins in the legs cannot pump blood back to the heart, a pool of blood collects in the lower limbs, followed by extreme swelling.

What are the symptoms of arterial v/s venous ulcers?

The most common symptom seen in the two conditions is pain and swelling. Destruction of the skin and tissue is also a common feature of arterial and venous ulcers, but these conditions are very different when presented to a healthcare provider. Undertaking a thorough assessment is essential.

Symptoms of arterial ulcers

Patients with arterial symptoms often complain about worsening pain on any kind of activity and relief on resting. In severe conditions, pain can elevate even when a patient rests.

Typically, arterial ulcers occur on the toes, feet, heel, or outer area of the ankles. Other characteristics include:

  • Ulcers appear to be red, yellow, or black.
  • Deep wounds
  • Hairless, tight skin around the ulcer
  • Leg pain mostly at night
  • No bleeding
  • The affected area seems cold.
  • Increasing redness on a dangled leg and paleness when elevated

Symptoms of venous ulcers

Initially, patients with venous ulcers notice edema (swelling), itching, and cramping in the blocked area.

Venous ulcers appear just below the knee or the inner part of the ankles. Noteworthy characteristics are:

  • Inflammation
  • Thick or hardened skin looking brown or black
  • Swelling
  • Itching
  • Scabbing or flaking
  • Discharge

It is essential to know the differences between arterial and venous ulcers to adopt the correct line of treatment. Doctors and nurses certified in wound care and vascular medicine have the most knowledge and experience in treating venous and arterial wounds. For a medical professional, cleansing the wound regularly and debridement are essential factors.

FAQs:

Q: Can you have both PAD and CVI?

A: Yes, a patient can suffer from both Peripheral Artery Disease (PAD) and Chronic Venous Insufficiency (CVI). It is commonly seen in those with comorbidities such as diabetes and obesity. Since PAD and CVI share common risk factors, they are often difficult to diagnose and frequently co-exist.

Q: Are arterial ulcers wet or dry?

A: Typically, arterial ulcers are dry owing to minimal drainage, unlike venous ulcers. An arterial ulcer appears to be ‘punched out.’ The base is grey or yellow, along with a dry scab. The tissue surrounding it looks pale, itchy, and shiny from the outside. Sometimes, ulcers can be of a mixed etiology and difficult to diagnose.

Q: How are arterial ulcers diagnosed?

A: An arterial ulcer is diagnosed clinically with a thorough physical examination and medical history. In the U.S, 15% to 20% of leg ulcerations have a mixed etiology. If the symptoms seem unclear, doctors may conduct a series of tests such as the ankle-brachial index, colour duplex ultrasonography, venography, and plethysmography.

Q: What is the best treatment for arterial ulcers?

A: While the human body can heal arterial wounds on its own, those with risk factors or underlying medical conditions need specialised care. The primary goal is to improve blood circulation in the area. Doctors recommend wound care, timely examination, and treating the underlying cause with medication. Surgeries such as angioplasties are also suggested in some cases to restore blood flow.

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