The key difference between arterial and venous ulcers is that arterial ulcers are due to ischemia while venous ulcers are due to stagnation of blood under pressure.
Ulcers are a common problem. Venous and arterial ulcers are two different entities with regard to causatives, clinical features, and location. This article will talk about both venous ulcer and arterial ulcer in detail, highlighting their clinical features, symptoms, causes, investigation and diagnosis, prognosis, treatment, and finally the difference between arterial and venous ulcers.
CONTENTS
1. Overview and Key Difference
2. What are Arterial Ulcers
3. What are Venous Ulcers
4. Side by Side Comparison – Arterial vs Venous Ulcers in Tabular Form
5. Summary
What are Venous Ulcers?
Venous ulcers are due to high blood pressures in the superficial veins. Leakage of blood under high pressure from the deep veins into the superficial system, particularly in the region of constantly placed perforators over the medial side of the leg, results in venous dilatation, leathery induration, and pigmentation of the skin as a result of stagnation of the circulation and eventually ulceration. A suggestion is that the deposition of fibrin outside the capillose wall and the trapping of white cells in the microcirculation are responsible for impairing the transportation of oxygen and nutrients to the tissues, resulting in the pathological changes found.
Patients with venous veins may have a past history of deep vein thrombosis, and they may have visible varicosities of the superficial system. Also, upon investigation, many patients will show to have had a previous unrecognized deep vein thrombosis or venous hypertension owing to deep vein valve incompetence. Signs of venous ulcers include varicose veins, perforator incompetence, and, lipodermatosclerosis.
Figure 1: Varicose veins are a sign of Venous Ulcers
Over 95% of the venous ulcers occur in the distal third of the leg on the medial side. Correcting any general disorder, in particular obesity, cardiac failure, anemia, vitamin deficiency, serious debilitating illnesses, appropriate dressing, applying compression bandages, and elevating the limb help venous ulcer healing. Surgical methods like skin grafting, perforator ligation, and saphenous ligation can also help to address the underlying condition.
What are Arterial Ulcers?
Skin ischemia, usually in association with atherosclerotic peripheral vascular disease, causes arterial ulcers. Ulceration normally occurs on the toes, dorsum of the foot, anterior tibial area, or heel and appears as patches of dry gangrene. Buerger’s disease, a disease seen in men aged between 20 and 40 years, may also be associated with skin gangrene. Small vessel vasculitis may also cause ulceration in patients with rheumatoid arthritis and other collagen disorders.
Figure 2: Ulcers
Arterial insufficiency may be evident from a history of intermittent claudication, rest pain, or the presence of ischemic changes of the limb. Presence of the ulcer suggests severe ischemia; therefore, local treatment of the ulcer is unlikely to be successful unless arterial supply is restored. Pain relief is necessary because pain can be so severe that the patient needs regular painkillers. Cessation of smoking is essential. The dressing should be simple, and dry gangrene area should be exposed. Loose slough has to be cleaned, and pus drained. Direct arterial surgery and lumbar sympathectomy can help to restore the circulation.
What is the difference between Arterial and Venous Ulcers?
There are distinct differences between arterial and venous ulcers depending on their cause, location, pain, and severity. Among them, the key difference between arterial and venous ulcers is their cause. Arterial ulcers are due to ischemia while venous ulcers are due to stagnation of blood under pressure. Moreover, place of occurence also makes a difference between arterial and venous ulcers. That is; arterial ulcers occur on weight bearing points while venous ulcers occur on the medial side of the leg.
Furthermore, while venous ulcers bleed profusely, arterial ulcers do not. In addition, pain is another difference between arterial and venous ulcers; arterial ulcers are painless due to associated neuropathy while venous ulcers are painful.
Below infographic on the difference between arterial and venous ulcers shows all these differences side by side.
Summary – Arterial vs Venous Ulcers
In brief, there are distinct differences between arterial and venous ulcers with regard to causatives, clinical features, and location. Among them, the key difference between arterial and venous ulcers is their cause; arterial ulcers are due to ischemia while venous ulcers are due to stagnation of blood under pressure.
Image Courtesy:
1. “Varicose veins-en” By Jmarchn, modified from Varicose veins.jpg of National Heart Lung and Blood Institute (NIH) – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “Ulcers, fissures, and erosion” By Madhero88 – Own work (CC BY-SA 3.0) via Commons Wikimedia
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