Leg ulcers are one of the most prominent signs of peripheral vascular disease (PVD). However, it is worth understanding that poor blood flow circulation may occur both due to peripheral arterial disease (PAD) or peripheral venous disease (PVD).

These conditions affect very different kinds of blood vessels. Nonetheless, they might share many traits. After all, changes in both the arterial and venous flow would cause disruption in the blood flow and thus leg ulcers.

Nonetheless, these conditions are significantly different from each other. In the case of PAD, blood is not reaching the legs in sufficient volume. It means pain in the calves when walking and heaviness in the leg. Such pain gets worse on physical exertion.

However, in the case of blockage of veins, blood flow to the legs is still more or less adequate, but it fails to return tocirculation. This causes an accumulation of fluids and other materials in the lower extremities, causing edema. When obstruction of arteries or veins becomes too severe, a person may develop leg ulcers.

Both PAD and PVD may cause leg ulcers, but symptoms may differ

Although both PAD and PVD may cause leg ulcers, they have different symptoms.

In the case of PAD, there is just not enough blood flow to the lower legs. It means pain in the leg when active but relative relief on rest. This also makes the legs feel weak and numb, and there are changes in skin color, temperature, weak pulse, and formation of dead tissues1.

Arterial ulcers also differ a bit with red or yellow sores, hair-less skin, deep wounds and yet lack of bleeding, and legs are cold on touch. These ulcers are also more likely to form on the outer side of the feet, ankle, heels, or toes.

In the case of PVD, symptoms are slightly different. There are visual changes like veins appearing on legs, spider veins, and even varicose veins. Apart from that, there is swelling of the legs, and they feel heavy. In addition, a person is prone to leg cramps. Unlike PAD, pain may worsen by sitting for long in the same position2.

Venous ulcers also differ from arterial ulcers. They are less likely to be painful. Nonetheless, there is significant inflammation, swelling, hardening of the skin, and discharge from the ulcers.

What causes peripheral vascular disease?

Although local symptoms like leg ulcers may sound alarming, it is vital to understand that peripheral vascular disease is secondary to systemic disorders. For both arterial and venous diseases, genetic causes are a predisposing factor. However, arterial, and venous diseases occur due to different reasons.

When it comes to arterial disease, the condition mainly occurs due to atherosclerosis. Thus, risk factors are conditions like diabetes, smoking, high blood pressure, trauma, and vasculitis, to name a few.

In the cases of the veinous disease, causes could be varicose veins, trauma, obesity, blood clotting disorders, deep vein thrombosis, heart failure, and other issues.

Diagnosis of peripheral vascular disease

Diagnosing the peripheral vascular disease would need both diagnosing the systemic disorder and local inspection and imaging. Once the chronic leg ulcer is diagnosed and confirmed to be due to vascular deficiency, doctors would try to determine if it is due to a venous or arterial condition.

Generally, diagnosing the ulcer related to PVD is more straightforward, and extremities inspection can suggest venous disease. Nonetheless, some conditions like deep vein thrombosis would require more thorough testing. For example, blood tests may help diagnose clotting defects.

In the case of arterial disease, the diagnostic approach is more complex. For example, there might be pain on palpation, muscle atrophy, cold skin, absence of pluses, and more on physical examination.

Although signs and symptoms may help, generally, doctors would opt for imaging methods like doppler ultrasound imaging, venography, and VQ scan (a test used to detect a blood clot in the lungs).

Treatment approach to leg ulcers due to poor circulation

Although vascular management is the mainstay of the treatment of leg ulcers due to poor circulation, many other treatments are needed. Thus, multi-specialist teams manage chronic leg ulcers. This would involve treatment for various chronic ailments, the use of antibiotics, physical treatment, and more.

It is vital to understand that taking care of leg ulcer wounds is quite challenging. Moreover, therapy for ulcers due to venous causesand arterial causes may differ considerably.

Thus, doctors may use anti-coagulation therapy, sclerotherapy, radiofrequency ablation, endovenous laser treatment, and so on in the case of venous ulcers. Most often, the aim of treatment is mainly to improve blood flow and close the defective veins.

When it comes to arterial disease, the approach differs as the prime aim is to open the closed artery or bypass it so that blood flow can be revived. Thus, doctors may use balloon angioplasty, stenting, and even bypass surgery. The choice of treatment would depend on the severity of the condition.

However, that is not all, and doctors may need to carry out other surgical interventions to promote healing, like wound debridement (removing dead tissues and promoting healing). Some people may also require plastic surgery and other similar interventions.

To conclude, leg ulcers may occur due to many disease conditions like diabetes, varicose veins, deep vein thrombosis, atherosclerosis, etc. In addition, these ulcers may occur due to either arterial or venous insufficiency caused by these illnesses. Thus, the treatment must focus on managing the systemic ailment that caused the vascular disease and endovascular intervention to promote quick healing of leg ulcers. Endovascular interventions can also help prevent future episodes and provide prolonged relief.

References

  1. Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. In: StatPearls. StatPearls Publishing; 2022. Accessed April 11, 2022. http://www.ncbi.nlm.nih.gov/books/NBK430745/
  2. Meissner MH, Moneta G, Burnand K, et al. The hemodynamics and diagnosis of venous disease. Journal of Vascular Surgery. 2007;46(6, Supplement):S4-S24. doi:10.1016/j.jvs.2007.09.043