How Do I Know I Have a Venous Ulcer Versus an Arterial One?

Since both arterial and venous ulcers are open sores normally located on the lower extremities, it’s easy to get the two confused. However, they are two separate types of wounds that require different care. Learn more about the two to find out which one you may have. Then, seek medical care for the wound and the underlying cause.

How Do Venous Ulcers Form?

If your veins have trouble moving blood from the lower extremities to your heart, the blood will pool. Pooling blood damages the veins, causing fluid and blood cells to leak. Once this process begins, you will start to notice leg swelling, initially that comes and goes. This leakage causes inflammation which results in poor healing. The skin around the ankle becomes friable and is easily damaged.  These areas commonly are itchy and over time become discolored.  This combination of inflammation and poor healing may eventually lead to the formation of a venous ulcer. Thus, these ulcers are common in people who suffer from varicose veins and deep vein thrombosis.

How Do Arterial Ulcers Form?

If you have blocked arteries, you could develop arterial ulcers. The arteries deliver oxygen and nutrients to tissue throughout the body. If they’re blocked, nutrient-rich blood won’t reach the lower extremities, leading to arterial ulcers. These ulcers are usually more painful and symptoms of claudication may have been present leading up to the point of ulcer formation.  Claudication is when pain begins in the legs after walking related to the blocked arteries. The walking results in the need for more oxygen to the leg muscles, but since the arteries to the leg muscles are blocked, the muscle starts to cramp up and become painful. Claudication can become so severe that a person may only be able to walk a few hundred feet before the pain begins and the person has to stop and rest. Eventually claudication can lead to rest pain and arterial ulcer formation.

Characteristics of Venous Ulcers

Venous ulcers typically form on the ankles and lower legs. These ulcers are shallow, superficial, and irregularly shaped. They vary in size and may be painful but not as severe as with an arterial ulcer.

If you have venous ulcers, you might have other symptoms as well, including  swelling, aching, pain, cramping, and restlessness. The ulcers might itch and could have some discharge.

Characteristics of Arterial Ulcers

Arterial ulcers generally form on the heels, outer ankles, and the tips of your toes. You’ll notice smooth edges around the wound. Also, the wound is generally round and has what’s referred to as a “punched out” look due to the deepness of the ulcer.

If you have arterial ulcers, you’ll also notice that the skin is tight and hairless, and it will form black, yellow, or red sores. These wounds don’t bleed and feel cool to the touch because of poor blood circulation. You’ll notice that the affected leg is more pale in color.

These ulcers can become quite painful at night, causing many people to sleep in upright positions in an attempt to get increased blood flow to the leg.

Seeking Treatment for Venous and Arterial ulcers

If you have an arterial ulcer, you will require additional testing including ankle brachial index testing, diagnostic ultrasound and even possibly contrast enhanced CAT scan or MRI, depending on the suspected area of blockage.  These blockages can now be treated with angioplasty and stent placement within the arteries, which represent less invasive forms of treatment compared to prior traditional arterial bypass surgeries.  Blocked arteries can even be opened nowadays with thrombectomy and atherectomy devices.  You may need to visit a wound care center to care for the arterial ulcer until it heals completely.

If you have venous ulcers, you can schedule a consultation with Dr. Vinay Madan at the Center for Varicose Veins. After evaluating your ulcers, Dr. Madan might recommend minimally invasive treatment for varicose veins. Dr. Madan offers sclerotherapy, Varithena, endovenous laser ablation (EVLA), VenaSeal, and radiofrequency ablation (RFA) for varicose veins. Once your veins are treated, you should stop developing venous ulcers.

Author
Dr. Vinay Madan, MD, DABVLM Dr. Vinay Madan, MD, DABVLM Dr. Vinay Madan is a board certified Interventional Radiologist and Phlebologist with over 25 years of experience in treating vein disease. Dr. Madan has served as the Chairman of Radiology and Section Head of Vascular Interventional Radiology at Eastern Connecticut Health Network. Dr. Madan brings a wealth of knowledge which allows him to treat patients with cosmetic and medical vein disease in a caring and compassionate way.

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