It is important to know arterial vs venous ulcer differences. Progressive vascular disease affects millions of individuals worldwide. In the US alone over 8.5 million individuals suffer from peripheral arterial disease (PAD) and more than 6 million have chronic venous insufficiency (CVI) [1,2]. Over many years, these diseases injure arteries and veins and disrupt healthy blood flow in the body. This eventually damages tissues such as muscles, nerves, and skin that rely on this blood supply. As the disease progresses, clinically complex symptoms like pain, functional limitations, and skin ulceration may occur.
In fact, vascular disease causes >90% of chronic leg ulcers, with approximately 70% caused by venous insufficiency, 5-10% caused by arterial disease, and up to 26% having a mixed arterial and venous disease [3,4]. These facts may be particularly surprising if you’ve looked to a dermatologist, podiatrist, or a wound specialist in the past to manage ulcers.
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Dr. Michael Lalezarian
Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in minimally invasive endovascular arterial revascularization. He is a committed partner in the battle against the devastating consequences of advanced vascular disease.
Terry T, October 2022
What Causes Arterial vs Venous Ulcers?
Arteries and veins work together to bring blood towards and away from all parts of the body. Dysfunction of either part of this system can have the common outcome of skin ulceration. There are differences between arterial and venous ulcer causes, so read below.
What Causes Arterial Ulcers?
What Causes Venous Ulcers?
Difference Between Arterial and Venous Ulcers
While destruction of the skin and underlying tissues is a feature of both diseases, arterial ulcers and venous ulcers are clinically different in terms of how they present, what they look like, and what the affected individual experiences. It is possible to have mixed arterial and venous disease. Learn more about the differences between arterial and venous ulcers below.
Arterial Ulcer Signs & Symptoms
Venous Ulcer Signs & Symptoms
Patients with vein disease have a varied combination of signs and symptoms. Initially, they experience edema, or swelling, past the area of blockage, fatigue, itching, cramping, and pain that improves with rest and leg elevation . Importantly, venous symptoms are not associated with exercise. As the severity increases, other signs of venous insufficiency are observed, such as spider veins or “telangiectasias”, varicose veins, constant swelling, fat destruction or “lipodermatosclerosis”, and destructive skin changes usually at the lower third of the leg, but anywhere between the knee and ankle [4,9,10,11]. Skin at this point often appears pale, hard, hyperpigmented, hairless, and thin or ulcerated . Venous ulcers are shallow and irregularly shaped with red granular tissue, fibrinous material, and sometimes calcification. [3,9] Pain is usually less severe with venous ulcers than arterial ulcers. Arterial ulceration is also associated with greater clinical severity and comorbidity. See venous insufficiency pictures.
Treatment Options for Arterial vs Venous Ulcers
The treatment of vascular ulcers focuses on healing not only the visible ulcer, but also addressing the underlying disease processes that created them. While treatment approaches differ greatly between arterial and venous ulcers, care must be taken in both cases to minimize the risk of infection and manage active wounds.
Arterial Ulcer Treatment
In arterial disease, the initial focus of treatment is on modifying risk factors through lifestyle changes and medications. For symptomatic disease, minimally invasive procedures and more invasive surgical options exist that improve blood delivery past the arterial narrowing or blockage. Procedural approaches to arterial disease are commonly referred to as revascularization because the end goal is to re-vascularize the affected extremity. A variety of minimally invasive tools may be used to open up blocked arteries and heal arterial ulcers. These can include atherectomy, angioplasty, and stenting, among others. For severe disease that cannot be addressed with minimally invasive techniques, arterial bypass surgery, endarterectomy, and even amputation surgery may be offered. These interventions, though invasive, can greatly alleviate symptoms and improve quality of life .
Venous Ulcer Treatment
Treatment for patients with venous disease is centered on reducing swelling through leg elevation and compression therapy, eliminating varicose veins, and improving flow in the deep veins if necessary. [2,4] Management also includes lifestyle changes such as exercise and weight loss to improve blood flow through the veins. Varicose veins can be addressed with minimally invasive vein closure or surgical vein stripping. Varicose vein treatment alone may be sufficient to allow venous ulcers to heal, but for more progressive disease that fails to respond to minimally invasive strategies, surgical options may be offered. For example, valves within deep veins can be fixed using reconstruction and transplantation; or bypass surgery may be offered in the case of an intractable flow obstruction [2,7]. Read more about venous ulcer treatment.
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Who Treats Vascular Ulcers?
Vascular Ulcer Care in Los Angeles
Peripheral Artery Disease Screening: Why Early Detection is Critical in PAD
Endovascular Treatment of
Lower Extremity Arterial Disease
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Learn more about Los Angeles Vascular Specialist Dr. Michael Lalezarian.
 Peripheral Arterial Disease (PAD) Fact Sheet. Centers for Disease Control and Prevention; 2016. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm. Accessed November 25, 2019.
 Patel SK, Surowiec SM. Venous Insufficiency. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. http://www.ncbi.nlm.nih.gov/books/NBK430975/. Accessed November 25, 2019.
 Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers. 2013;2013:1-9.
 Hedayati N, Carson JG, Chi Y-W, Link D. Management of mixed arterial venous lower extremity ulceration: A review. Vasc Med. 2015;20(5):479-486.
 Conte SM, Vale PR. Peripheral Arterial Disease. Heart, Lung and Circulation. 2018;27(4):427-432.
 Shu J, Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379-381.
 Eberhardt RT, Raffetto JD. Chronic Venous Insufficiency. Circulation. 2014;130(4):333-346. doi:10.1161/CIRCULATIONAHA.113.006898
 Meulendijks AM, de Vries FMC, van Dooren AA, Schuurmans MJ, Neumann HAM. A systematic review on risk factors in developing a first‐time Venous Leg Ulcer. J Eur Acad Dermatol Venereol. 2019;33(7):1241-1248.
 Salcrido, R. C. Arterial vs Venous Ulcers: Diagnosis and Treatment: Advances in Skin & Wound Care. 2001;14(3):146-147.
 Grey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006;332(7537):347-350.
 Dean SM. Cutaneous Manifestations of Chronic Vascular Disease. Progress in Cardiovascular Diseases. 2018;60(6):567-579.
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