Leg ulcers are chronic non-healing wounds on the lower limbs primarily caused by vascular disorders. They significantly affect a person’s quality of life due to the pain, limitation of movements, and likelihood of developing infections. The two significant types are venous leg ulcers and arterial leg ulcers, which have different characteristics and management approaches. It is essential to be aware of these differences as it aids in understanding Learn the key Difference Between Venous Leg Ulcers and Arterial Leg Ulcers to understand their causes, symptoms, and appropriate treatments effectively. are to be managed and treated.
What is an Arterial Leg Ulcer?
An Arterial Leg Ulcer is an ulcer on the lower leg resulting from impaired circulation in lower limb arteries. Lack of blood supply, mainly due to arterial diseases, compromises tissue viability by causing ischemia, culminating in ulcer formation. These ulcers are typically severe and may take a long time to heal due to the decreased blood circulation in the affected area.
Symptoms of Arterial Ulcer
Arterial ulcers have several characteristic symptoms that can help in their identification:
Location
Arterial ulcers are localized, specifically in the toes, feet, and the shin or lateral malleolus of the ankle. These areas are susceptible to the development of ulcers since they have poor blood circulation.
Appearance
A typical characteristic of these ulcers is that they are round and have punched-out margins with either a pale or necrotic bottom. There are little secretions, and the ulcer does not tend to bleed freely. The skin surrounding the area can be atrophic. It is also commonly thin.
Pain
Symptoms are usually severe and become worse during the night or when the leg is put on a raised level. This is due to the limited blood circulation, which lowers the circulation when the leg is lifted.
Skin Changes
The surrounding skin may become thin, smooth, and shiny, and sometimes, there may be no hair in that area. In the case of peripheral vascular disease, there may be complete amenorrhea in the affected limb. Further signs include altering the skin’s texture and temperature, whereby the skin may be cold or clammy.
Other Symptoms
Pain, numbness, abnormal skin colour or texture, decreased/absent pulse, cold skin, bluish discoloration, hypotension, and possible gangrene. Patients may also develop claudication, the leg pain that occurs during physical activity involving the use of the legs, and ease with inactivity.
Causes of Arterial Ulcer
Several factors contribute to the development of arterial ulcers, primarily related to conditions that impede blood flow:
Peripheral Artery Disease (PAD)
One of the diseases frequently associated with artery constriction by atherosclerosis. This condition results in peripheral ischemia and ulceration. The blood supply to the tissues is being restricted.
Diabetes Mellitus
Can worsen conditions that cause plaque build-up in the arteries and decrease blood circulation and supply. Diabetic patients are at a higher risk because of other comorbidities that compromise peripheral blood flow through both macro and micro vascular mechanisms.
Hypertension Narrows Arteries
This increases the chances of ulcer formation due to high blood pressure. This also results in the development of atherosclerosis, wherein the arteries thicken and narrow, further impeding blood flow.
Smoking
Smoking increases the risk of PAD as well as atherosclerosis, which makes it a significant factor in speeding up the progression of the illness.
Hyperlipidemia
Cholesterol-ridden plaque may accumulate in the arteries. The cholesterol transported in the LDL particle can cause atherosclerotic plaques to collect on the arteries, making them less comprehensive.
Treatment of Arterial Ulcer
Effective management of arterial ulcers focuses on the improvement of blood flow to the affected area and addressing underlying conditions:
Revascularization: When imposing blood flow to an area of the heart through angioplasty or bypass surgery. These surgical interventions make the arteries porous, allowing blood to trickle freely.
Medications: Aspirin, other non-specific antiplatelet drugs, statins, and other drugs increase blood flow. These can assist in conditions like hyperlipidemia and hypertension, which are the root causes of other complications.
Wound Care: An ulcer dressing specializing in the area’s protective healing process. Special precautions should be taken to avoid acquiring infection, and proper techniques should be used to handle exudate.
Lifestyle Changes: Evidence included quitting smoking, changing eating habits, and exercising to enhance vascular health. These changes decrease the risk of a subsequent arterial complication.
Pain Management: Analgesics that may be used to address severe pain. Patient comfort is essential in managing pain to increase the patient’s quality of life.
What Does Venous Leg Ulcer Mean?
Venous leg ulcers stem from CVI – a condition whereby the veins that flow through the legs cannot pump blood back to the heart. This results in elevated pressure within these vessels, increased fluid leakage into the peripheral tissues, and ulceration. Venous ulcers are more prevalent than arterial ulcers and may be caused by prolonged venous hypertension.
Symptoms of Venous Ulcers
Venous ulcers have distinct symptoms that differentiate them from arterial ulcers:
Part of Body
Usually located on the medial side of the lower leg, above the ankle joint. In this area, organs are most vulnerable to increased venous pressure.
Appearance
Such ulcers are usually small and may have an irregular shape. They are commonly associated with varicose veins. The base is often red and yellow fibrin. They may also secrete large amounts of pus or other exudates.
Pain
Typically less severe than arterial ulcers but may become painful during prolonged standing. It is usually characterized as an ache or throbbing of the leg and can be eased by raising it.
Skin Changes
Skin in the region may be affected by Dermatitis, hyperpigmentation, lipodermatosclerosis, and increased skin thickness. The skin might be discolored, swollen, and might have a weeping nature to it.
Other Symptoms
Oedema of the lower limbs, sensation of fullness, and discharge of serous exudation from the ulcers. The leg cramps and itching are also possible symptoms that the patient might develop.
Causes of Venous Ulcers
Venous ulcers are primarily caused by conditions that lead to chronic venous hypertension:
Chronic Venous Insufficiency (CVI)
The primary cause in many cases is the malfunction of venous valves that allow blood to flow back to the heart. These valves do not shut well, which causes the blood to stagnate in the lower parts of the body.
Deep Vein Thrombosis (DVT)
Prior DVT can harm valves and very often results in CVI. Blood clot formation tends to impair the blood flow in veins and compromise the venous valves’ functioning.
Obesity
Obesity adds extra pressure on leg veins due to increased body weight. It likewise results in a sedentary lifestyle, which in turn aggravates venous insufficiency.
Prolonged Standing or Sitting
It may further elevate the venous pressure. Sedentary jobs usually involve sitting or standing, putting one at risk of getting venous ulcers.
Age
Risk is higher in middle-aged adults as valves of the veins wear out with age. Venous pressure increases due to a reduction in the elasticity of the walls and valves of veins.
Treatment of Venous Ulcers
Managing venous ulcers involves improving venous return, reducing swelling, and promoting wound healing:
Compression Therapy: Using gloves, stockings, or bandages to facilitate the venous return and minimize edema formation. The primary management strategy in venous ulcer treatment is compression.
Wound Care: Sustaining minor dressing changes for the ulcer to avoid infection and optimize healing. However, proper dressings should be applied to absorb the produced exudate and cover the wound.
Medications: If the ulcer is infected, topical or oral antibiotics will be used, depending on the severity of the infection. Also, medicines for other primary illnesses, such as hypertension or diabetes, may be recommended.
Surgery: In more advanced cases, invasive measures such as vein stripping, sclerotherapy, or skin grafting could be called for. These surgeries are aimed at correcting the defects in venous return.
Lifestyle Changes: Proper diet, elevation of legs, and some exercises that would help improve blood circulation. They are primarily invasive procedures that can help increase venous return and minimize the chance of the disease returning.
To Learn More About Venous Leg Ulcers: https://airenvascular.com/blog/understanding-venous-leg-ulcers/
Differences Between Arterial and Venous Ulcers
| Feature | Arterial Ulcers | Venous Ulcers |
| Target Body Parts | Toes, feet, lateral ankles | Medial lower legs, above ankles |
| Looks | Punched-out, well-defined edges, pale base | Shallow, irregular borders, red base |
| Amount of Pain | Severe, worse at night or when elevated | Less severe, increases when standing |
| Changes occur in the skin | Shiny, taut, hairless skin, absent pulses | Dermatitis, hyperpigmentation, varicosities |
| Root Cause | Inadequate blood supply, atherosclerosis | Chronic venous insufficiency, faulty valves |
| Risk associated Factors | PAD, diabetes, hypertension, smoking | CVI, DVT, obesity, prolonged standing |
| Treatment to be given | Restoring blood flow, managing pain | Improving venous return, reducing swelling |
When to Seek a Doctor’s Advice
It is important to consult a doctor early if you are worried you have developed these signs and symptoms to avoid the development of complications and not clear about difference between arterial ulcer vs venous ulcer . Medical advice and a specific regimen as per the problem are given by Dr. Ashish Airen, who is a vascular specialist who also specializes in varicose veins treatment, diabetic foot treatment, gangrene treatment, and all the related vascular problems. To get a consultation with Dr. Ashish Airen, book an appointment and visit his clinic for earlier and better treatment.
Some Symptoms Assuring a Visit to the Doctor for Leg Ulcers
- Non-Healing Wounds: If a wound does not heal for the next few weeks.
- Severe Pain: Chronic and severe abdominal pain that is not manageable using normal analgesic drugs.
- Signs of Infection: These include erythema, heat, edema, and pus formation over the ulcer site.
- Systemic Symptoms: Headache, which may suggest growing inflammation within the brain tissue.
- Worsening of Symptoms: These include worsening of the ulcer area, increased pain or discharge from the ulcer.
Summary
It is critical in the management of leg ulcers to understand the distinction between difference between arterial and venous ulcers. Arterial ulcers cause poor blood flow and need surgical or medical measures to overcome it. In contrast, venous ulcers are caused by inadequate blood return and can be treated using compression and various patient behaviour modifications suggested by vascular surgeon. Annually, people with these chronic diseases receive adequate diagnosis, treatment, and lifestyle modification that improves their quality of life.