Treating Arterial vs. Venous Ulcers with the Right Products

Aug 28

Two patients present with lower leg ulcers. At a glance, the wounds seem similar, but the underlying causes of arterial and venous ulcers are complete opposites.

One is caused by a blood flow "delivery" problem (ischemia), the other by a "return" problem (venous hypertension).

This distinction is critical. The best treatment for one is harmful to the other. Getting the diagnosis right from the start is the most important step toward wound healing.

Arterial vs. Venous Ulcers: Know the Difference

Accurate identification begins with understanding what causes each type of ulcer and knowing the distinct signs they present.

Venous Ulcers: A "Return" Problem

Venous ulcers are the most common type of leg ulcer.

They happen when the valves in a patient's leg veins fail to work correctly, a condition known as venous hypertension. This causes blood to pool in the lower legs, increasing pressure and breaking down the skin.

Characteristics

Location. Typically found in the "gaiter area," between the ankle and the knee.
Appearance. Often large and shallow with irregular borders.
Drainage. Usually have moderate to heavy fluid drainage or exudate.
Surrounding Skin. The skin may be swollen and have a brownish discoloration from iron deposits (hemosiderin staining) or show signs of hardening (lipodermatosclerosis).
Pain. Discomfort often improves when the legs are elevated.
Physical Exam. Pedal pulses are typically present and palpable.
Patient History. Often associated with a history of Deep Vein Thrombosis (DVT), obesity, or jobs involving prolonged standing.

Arterial Ulcers: A "Delivery" Problem

Arterial ulcers are caused by poor circulation from blocked or narrowed arteries, a condition called ischemia. This is often due to peripheral arterial disease (PAD).

The tissue simply doesn't get enough oxygen-rich blood to survive, and an ulcer forms.

Characteristics

Location. Often appear on the feet, heels, tips of toes, or between the toes, where circulation is poorest.
Appearance. Tend to have a "punched-out" look, appearing deep with well-defined, even borders. The wound bed itself is often pale, gray, or yellow with little to no drainage.
Surrounding Skin. The skin may be cool to the touch, shiny, and hairless. Patients often report severe pain, especially at night or when their legs are elevated.
Pain. Pain is often severe, especially at night (rest pain) or when the legs are elevated. It may be relieved by dangling the feet over the side of the bed.
Physical Exam. Pedal pulses (dorsalis pedis and posterior tibial) are often weak or absent. The toes will have a long capillary refill time.
Patient History. Patients may report cramping pain in the calf during exertion (intermittent claudication). Risk factors include smoking, diabetes, high cholesterol, and hypertension.

Why an Accurate Diagnosis Is Crucial

The causes of arterial vs. venous ulcers are significantly different, which means their treatments are too. An incorrect diagnosis can lead to a therapy that makes the wound worse.

For example, the cornerstone of venous ulcer treatment is compression.

However, applying compression to an arterial ulcer is extremely dangerous. It would further restrict already poor blood flow and could lead to tissue death and potential amputation.

Using a diagnostic tool like the Ankle-Brachial Index (ABI) is crucial to assess blood flow and confirm the diagnosis before starting any treatment.

An ABI result of less than 0.9 suggests PAD.
A result below 0.5 indicates severe disease. Do NOT use compression.
An ABI between 0.8 and 1.4 generally shows that compression is safe.

Contrasting Treatment Approaches for Arterial vs. Venous Ulcers

Once you have an accurate diagnosis, the treatment paths become clear and distinct.

Treating Venous Ulcers

The primary goal is to manage the underlying venous hypertension. This is achieved mainly through compression therapy, which helps the veins push blood back toward the heart.

Treatment also involves elevating the legs and using dressings that can effectively absorb heavy drainage to protect the surrounding skin.

Treating Arterial Ulcers

Here, the focus is entirely on restoring blood flow to the area. This often requires a referral to a vascular specialist for procedures that can open the blocked arteries (revascularization).

Compression therapy should never be used unless under specific guidance.

Wound dressings are chosen to keep the wound moist and protected without putting any pressure on the limb.

Patients will also have to make lifestyle changes, quitting smoking and managing risk factors like diabetes and high blood pressure.

The "Third" Diagnosis: Mixed-Aetiology Ulcers

Unfortunately, many patients don't fit neatly into one category. A significant number of patients (about 20%) have both venous and arterial disease present.

This diagnosis requires a careful balancing act. It can involve modified or reduced compression under expert management to avoid compromising arterial supply.

Advanced Solutions for Complex Chronic Wounds

Addressing the underlying cause is the first step. Yet, some chronic arterial and venous ulcers still struggle to close and require advanced support.

That's where RenewMed helps. We're a national distributor of the highest quality skin substitute grafts.

These advanced products provide a scaffold for the body's own cells to build new tissue, which is essential for healing complex wounds. Our team understands the nuances of arterial vs. venous ulcers and helps you choose the right product for each specific condition.

We also offer a White Glove Service to handle the admin.

It's a full-service support system designed to handle the administrative and financial complexities. Your dedicated consultant manages insurance verifications, ordering, and partners with billing experts for timely payments.

Now you can focus on patient outcomes while we handle the rest.

Let's talk about advancing your health care.

Together, we can make a difference, one patient at a time.

Sources Used

Disclaimer: This content is created for licensed healthcare professionals, offering educational insights into wound care. It is not intended as medical advice or to replace your own clinical judgment when treating patients. We're here to support you, but the final treatment decisions should always be based on your professional evaluation of each unique patient's needs.

Tony Altieri