Understanding the Key Differences: Venous Leg Ulcers vs. Arterial Leg Ulcers

Leg ulcers are open wounds that occur on the lower extremities, especially between the knee and the ankle. These wounds don’t heal easily and cause immense trouble.

Besides being painful, if they are left untreated, they could get infected, making the wounds worse.

There are different types of leg ulcers, such as venous ulcers, arterial ulcers, pressure ulcers, traumatic ulcers, etc.

But often, people get confused between venous and arterial ulcers. Both ulcer types occur when the affected area experiences issues with smooth blood flow. So this article is all about venous versus arterial ulcers.

What is a venous leg ulcer?

Also known as a venous stasis ulcer, this wound is formed in the lower part of your legs, particularly near your ankle, when the vein and blood flow in these parts get affected.

This type of ulcer affects more than 1 percent of the US population, with older people and women being more affected. 

Venous ulcers, though treatable, take several months to heal and if they are severe, the ulcer never heals.

How do venous leg ulcers form?

The veins usually consist of one-way valves that keep blood flowing up toward your heart. Venous ulcers occur in your lower legs when high pressure affects the veins, damaging the tiny blood vessels present there.

This increase in pressure prevents the supply of nutrients and oxygen from getting to the tissues. So, the lack of nutrient supply kills the cells, damaging the tissue and resulting in an open wound.

Who is at risk of venous leg ulcers?

You may have a chance of getting venous leg ulcers if you have previous leg injuries, varicose veins, habitual smoking, obesity or other blood circulation problems.

Signs and symptoms of venous leg ulcer

Individuals suffering from venous ulcers often experience the following symptoms:

• Itchy or burning feeling
• A rash or dry skin around the affected area
• Blood pooling with dark red, purple, brown, and hardened skin
• Leg swelling and heaviness

If the venous ulcer gets infected, you may notice

• Redness or swelling in the surrounding skin
• A foul-smelling pus leaking from the wound
• Severe pain
• Fever

Diagnosis of venous leg ulcers

 

Your doctor will physically examine the venous ulcer by making you stand and lie down. To understand the severity of venous ulcers, you will be recommended that you do some tests that include

 

A Doppler study is conducted to listen to and understand if the blood flow is normal through your veins.

 

An ankle-brachial index test is employed to note the blood pressure reading of your arms and legs.

 

If there is any suspicion of infection, a sample from the ulcer may be taken to identify any bacteria present.

 

A CT scan or X-ray is utilized to find damaged or non-functioning valves in the veins.

 

Treatment for venous leg ulcer

1. Compression therapy is done to reduce swelling and improve blood flow in the legs. For severe cases, multi-layer bandaging provides graduated pressure and treats the wound.
2. Regular cleaning and dressing of the wound ulcer can keep the wound moist and protect it from infection. 
3. Dried, unwanted, dead or unhealthy tissues are removed using a process of debridement. 
4. If the venous ulcer is infected, antibiotics are used to treat it. 
5. To manage discomfort, doctors prescribe pain relievers.
6. Only in severe cases your healthcare professional might advise surgery to improve the circulation in your legs.

Some practical tips to manage venous leg ulcers:

Whether you sit or lie down, ensure your legs are elevated.

Walk regularly and avoid standing or sitting for an extended period of time. Also, exercise your legs by moving your feet up and down. These things help with blood circulation.

Take the prescribed medicines as directed by your healthcare professional.

How to prevent venous leg ulcers?

If you want to prevent venous leg ulcers, 

• Lose weight if you are obese
• Quit smoking
• Add healthy foods to your diet
• Manage your blood pressure and cholesterol levels.
• If you are diabetic, keep your blood sugar level under control.

Schedule an appointment with advanced wound care to get your venous leg ulcers treated.

What are arterial leg ulcers?

Arterial wounds, also called arterial ulcers or ischemic ulcers, are mainly caused by poor circulation of nutrient-rich blood to the lower parts of your body. This results in arterial ulcers, which are open wounds occurring in bony parts of the foot, toes and heals.

While venous leg ulcers affect your legs due to chronic venous insufficiency, This is the difference between both ulcer types.

How do arterial leg ulcers form?

When an artery in the leg becomes blocked, blood circulation is affected. So the necessary nutrients and oxygen are prevented. When this continues, the skin and the underlying tissues die and end up creating an open wound. Since there is poor circulation, it makes it difficult for the red blood cells(RBC) to carry the required nutrients the wound needs. This slows down the healing process and increases the risk of infection.

Who is at risk of arterial leg ulcers?

There are different causes of arterial ulcers and the people at risk of developing them are:

• High cholesterol
• Chronic kidney issues
• Smoking
• Diabetes
• Trauma
• Aging
• Limited mobility
• Peripheral vascular disease
• Chronic kidney issues

Signs and symptoms of arterial leg ulcers

Individuals suffering from arterial ulcers often experience the following symptoms:

• Weakness or numbness in the leg
• A non-healing open wound that’s painful
• The affected leg turns paler when lifted up or appears red when hanging down.
• Immense discomfort or pain, especially during the night

Diagnosis of arterial leg ulcers

First, the patient’s medical history is checked and based on it, the following tests are done for the diagnosis of arterial ulcers:

Doppler ultrasound is done to assess blood flow in the arteries and helps in identifying blockages or narrowing of the arteries.

A Buerger test is done where the patient is asked to raise their leg in a certain position. If the patient’s foot turns pale when elevated and turns bright red when lowered, the test is considered positive.

Ankle Brachial Pressure Index (ABPI) test is done to measure blood pressure at your ankle. If it’s low, it means the lower parts have reduced blood flow.

Transcutaneous oximetry is done to check for vascular insufficiency. If the test shows <20 mmHg, it means severe insufficiency.

A capillary refill time test is done to assess peripheral circulation and the efficiency of blood flow to the body’s extremities.

What are the treatment options?

Arterial wounds can heal on their own. But the problem is that the natural healing process is super slow due to poor blood circulation. 

This is why individuals suffering from arterial ulcers suffer from chronic pain and sores for months. 

To expedite the treatment, medications, wound care, lifestyle changes, surgical interventions and therapies are recommended by the healthcare professional. 

However, treating the underlying cause of arterial ulcers using antibiotocs can help reduce symptoms but doesn’t heal the ulcer completely.

So, here, healthcare professionals may recommend surgery such as angioplasty to restore blood flow to tissues and organs, along with treating the wounds with antibiotics.

In the worst case, if the blood flow can’t be restored in the area affected by the arterial ulcer, your limb will be amputated.

Some practical tips to manage and prevent arterial leg ulcers are:

• Keep your wounds clean.
• Avoid smoking during treatment because smoking can harden or clog the arteries that carry oxygen. This affects the blood supply.
• Strictly avoid prolonged sitting or standing.
• Avoid crossing your legs while seated.
• Physical activities such as exercises can be helpful. But exercise only when it’s comfortable.
• After treating the arterial wound, it’s recommended to wear special shoes or orthopedic devices to reduce the pressure on the sore.

Visit the top wound care center to get your arterial leg ulcers treated by experts.

Key differences between venous leg ulcers and arterial leg ulcers

 

Feature	Venous leg ulcers	Arterial leg ulcers
Location	Venous leg ulcers develop inside the leg, just above the ankle.	Arterial leg ulcers usually occur on the lower legs, ankles, feet or toes.
Causes	Venous leg ulcers are also caused by poor blood flow in your leg veins, which drain blood from the legs.	Also called ischemic ulcers or ischemic wounds, this is caused by peripheral artery disease (PAD), where the shortage of blood flow to the tissues damages the arteries that supply the legs.
Appearance	Venous ulcers show signs of pooling blood and show dark red, purple and brown spots as the skin hardens.	Arterial ulcers don’t bleed and are yellow, brown, gray or black in color.
Risks	Prolonged standing or sitting, obesity, pregnancy, history of deep vein thrombosis (DVT)	Smoking, diabetes, obesity, family history, hypertension, hyperlipidemia, peripheral artery disease (PAD) and a sedentary lifestyle.
Characteristic	Arterial ulcers are painful and uncomfortable, especially at night and when the leg is elevated and the wound is cool to touch.	Venous leg ulcers are mild to moderately painful and often relieved when elevated.
Treatment	Compression therapy, leg elevation, wound care and treating underlying venous insufficiency	Arterial ulcers require surgical intervention to improve blood flow in the affected arteries. When blood flow is restored, the symptoms will go away.
Healing time	Generally, the healing time is slower. It takes weeks to months, depending on the extent of venous insufficiency and treatment.	Since arterial ulcers are chronic and non-healing, they take months to years to heal.

Closing Notes

Recognizing the difference between venous leg ulcers and arterial leg ulcers is crucial to at least understanding what you are dealing with.

Venous leg ulcers are caused by insufficient blood flow in the veins, whereas arterial leg ulcers result from poor blood flow in the arteries due to different conditions.

We hope this article has a clear-cut explanation. If you find yourself dealing with any of the symptoms listed above, feel free to visit a wound treatment center and get it diagnosed and treated well.