Arterial vs Venous Ulcer

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?

While destruction of the skin and underlying tissues is a feature of both diseases, the differences between arterial 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 Symptoms & Signs

Arterial ulcer symptoms and signs are often characterized by aching pain that is worsened by activity and relieved with rest [5]. With severe disease, pain can persist even at rest. There is also an increased amount of destruction of the skin that causes it to breakdown and form ulcers. Arterial ulcers normally occur past the point of compromised blood supply, usually at the farthest parts of the body such as feet, toes, fingers, legs, side of the ankle, and areas of pressure to the skin. Arterial ulcers may be shallow or deep with sharp “punched out” borders. Oftentimes, the wound base is grey or yellow with associated gangrene and eschar (dry dark scab). Tissue surrounding the wound may be itchy, pale, and shiny [4,9,10]. These characteristics are very distinct from venous disease.

Venous Ulcer Symptoms & Signs

Venous ulcer symptoms and signs have a wide variety. Initially, patients experience edema, or swelling, past the area of blockage, fatigue, itching, cramping, and pain that improves with rest and leg elevation [2]. 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 [4]. 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.

Vascular ulcer treatments focus on healing not only the visible ulcer, but also addressing the underlying disease processes that created them. Arterial and venous ulcer treatment approaches differ greatly, care must be taken in both cases to minimize the risk of infection and manage active wounds.

Arterial Ulcer Treatment

For arterial disease treament, the initial focus 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 [5].

Venous Ulcer Treatment

Venous disease treatment 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.

Your Partner in Vascular Care

Who Treats Vascular Ulcers?