See a Vascular Ulcer Specialist

Patients walking on the beach after seeing a Vascular Ulcer Specialist
Vascular Ulcer Specialist Dr. Michael Lalezarian
At ProVascularMD, we provide comprehensive care for vascular ulcers and their complications. Browse our educational resources to learn more about symptoms, diagnosis, and treatment.

When you’re ready to see a vascular ulcer specialist, we’re here to help. Dr. Michael Lalezarian is double-board certified Vascular and Interventional Radiologist at ProVascularMD that specializes in vascular ulcers and minimally invasive therapies to treat them. Dr. L is a committed partner in the battle against vascular diseases. He values spending quality physician time with his patients to address their needs and concerns, and assist them on their journey to better health.

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“Dr. L changed my life. He’s knowledgeable, caring and my experience with his office staff was as good as it gets. I wish all of my doctor visits felt this way. After a few pregnancies I was having incredibly painful varicose veins that was really wearing on me. The treatment was practically painless and I’m so happy with my results. He’ll be my vascular doctor moving forward.”

Michelle H, February 2022

ProVascularMD credentials with UCLA David Geffen School of Medicine
ProVascularMD credentials with American Medical Association
ProVascularMD credentials with American Board of Radiology
ProVascularMD credentials with Society of Interventional Radiology
ProVascularMD credentials with Alpha Omega Alpha Honor Medical Society

Types of Vascular Ulcers

The presentation of a vascular ulcer varies by its underlying cause. Is your ulcer more consistent with an arterial ulcer or a venous ulcer? Learn more about the different types of vascular ulcers below.

Arterial Ulcers icon

Arterial Ulcers

Arterial ulcers are caused by severe atherosclerotic blockages in the arteries, usually in the legs. Arterial ulcers are the end stage of peripheral artery disease (PAD). When severe, insufficient arterial blood flow causes tissue loss in areas of the leg that aren’t sufficiently nourished. Arterial ulcers typically form on ankles, feet, or toes. They may be shallow or deep with sharp “punched out” borders. The wound base is usually gray or yellow with associated gangrene and dry dark scabbing.

Venous Ulcers icon

Venous Ulcers

Venous ulcers are caused by severely impaired blood flow in the veins of the legs. Venous ulcers are the end stage of chronic venous insufficiency (CVI). Similar to arterial ulcers, insufficient blood flow in the veins causes tissue loss in areas of the leg that aren’t sufficiently nourished. Venous ulcers are typically located in the lower third of the leg in the gaiter region. They are often shallow and irregularly shaped with red granular tissue, fibrinous material, and sometimes calcification.

Arteriovenous (Mixed) Ulcers icon

Arteriovenous (Mixed) Ulcers

Roughly 1 in 4 individuals with vascular ulcers have a mixed type where both peripheral artery disease and chronic venous insufficiency are contributing to vascular ulceration. These cases are referred to as arteriovenous ulcers. Arteriovenous ulcers share risk factors and symptoms of both arterial and venous ulcers, and tend to be associated with older age, lower body mass index, lower mobility, and lower health related quality of life when compared to venous ulcers on their own.

Vascular Ulcer Signs & Symptoms

Vascular ulcers can present with a variety of different signs and symptoms. These symptoms vary depending on which type of vascular ulcer you have. Get relief from the symptoms of vascular ulcers and get back on your feet. Visit us at ProVascularMD to learn how we can help.

Arterial Ulcers

Vascular Ulcer icon   Peripheral Artery Disease (PAD)

Arterial ulcers typically develop after many years of peripheral artery disease, and the symptoms of peripheral artery disease will continue past ulcer development. Leg discomfort, cold feet, weak pulse, and cramping pain when walking or at rest are common symptoms of peripheral artery disease.

Vascular Ulcer icon   Ankle, Feet, or Toes

Arterial ulcers are often found between or on the tips of the toes, on the heels, on the outer ankle, or where there is pressure from walking or footwear.

Vascular Ulcer icon  Sharp, Punched Out Borders

Venous ulcers typically develop after many years of chronic venous insufficiency, and the symptoms of venous insufficiency will continue past ulcer development. Spider veins, varicose veins, swelling, heaviness, and cramping are common symptoms of venous insufficiency.

Venous Ulcers

Vascular Ulcer icon   Chronic Venous Insufficiency (CVI)

Venous ulcers typically develop after many years of chronic venous insufficiency, and the symptoms of venous insufficiency will continue past ulcer development. Spider veins, varicose veins, swelling, heaviness, and cramping are common symptoms of venous insufficiency.

Vascular Ulcer icon   Gaiter Region

Venous ulcers tend to form in the gaiter region. This regions spans the lower third of the leg, including the ankle and the area just above it.

Vascular Ulcer icon  Shallow, Irregular Shape

Venous ulcers are recognized by their irregular shape, uneven borders, and shallow depth. The wound base is usually red, sometimes with yellow tissue. Venous ulcers are usually surrounded by hardened, discolored skin.

Vascular Ulcer Diagnosis

Diagnosis of vascular ulcers is focused on determining the underlying disease process. When you see a Vascular Specialist about your ulcer, they’ll use a combination of medical history, physical exam, and imaging techniques to determine what’s causing your ulcer and how to best treat it. Get the full workup at ProVascularMD, and get started on your journey to healthy legs.

Vascular Ulcer Physical Exam icon

Physical Exam

Vascular ulcer diagnosis begins with a detailed medical history and a physical exam. Your Vascular Specialist will inspect your ulcer and look for telling signs of vascular disease, such swelling, skin changes, cold feet, weak pulse, and other symptoms.

Vascular Ulcer Ultrasound icon

Ultrasound

Ultrasound is used to examine flow in the veins and the arteries. In the hands of a skilled ultrasound technician, ultrasound can identify blockages and backups in the vessels of the leg, and can often determine the root cause of vascular ulcers.

Vascular Ulcer Imaging icon

Imaging

Beyond ultrasound, more advanced imaging techniques may be used to get a more comprehensive understanding of your vascular system. CTA, MRA, contrast arteriography, and venography are commonly used in more complex cases of vascular disease.

Vascular Ulcer Treatment

The goal of vascular ulcer treatment is to open blocked vessels and to re-establish blood flow throughout the lower extremity. [treating PAD or vein disease] At ProVascularMD, we have extensive experience in [treatments]. We also partner with our colleagues in wound care, podiatry, endocrinology, vascular surgery, and other specialties that are essential to healing the lower extremities. Learn more about the treatments we offer for vascular ulcers below.

Peripheral Artery Disease (PAD) Treatment icon

Peripheral Artery Disease (PAD) Treatment

Effective treatment of arterial ulcers often involves addressing the underlying peripheral artery disease. Minimally invasive treatments for peripheral artery disease include angioplasty, stenting, and atherectomy, while surgical treatments include endarterectomy and bypass surgery.

Chronic Venous Insufficiency (CVI) icon

Chronic Venous Insufficiency (CVI) Treatment

Effective treatment of venous ulcers often involves addressing the underlying venous insufficiency. Depending on the location and extent of vein disease, treatments for venous insufficiency may include foam sclerotherapy, vein ablation, stenting, or thrombolysis.

Wound Care icon

Wound Care

Wound care is a necessary component of treating vascular ulcers. While peripheral artery disease and venous insufficiency treatments address the underlying cause of vascular ulcers, wound care is concerned with keeping ulcers clean, managing the surface of the wound, treating the skin to promote healing.

Be Confident In Your Care Decisions

Vascular Ulcer Education Center

Arterial vs. Venous Ulcers icon

Arterial vs. 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 symptoms the affected individual experiences. The appropriate course of treatment for each type of ulcer is also quite distinct, requiring the expertise of a Vascular Specialist to navigate effectively and return the leg to a healthy state. Learn more about the differences between arterial and venous ulcers in this in-depth review of ulcer causes, symptoms, and treatment options.

Amputation Prevention icon

Amputation Prevention

Amputation is associated with high mortality rates, high healthcare costs, and an irreversible reduction in quality of life. No matter the circumstance, the decision to amputate should not be made lightly. Rates of amputation have declined over the past two decades, but amputation is still a prevalent problem today. In fact, there are still over 50,000 incidents of vascular-related amputations in the United States annually. From our view, there’s still work to be done to bring this number down to include only the most necessary of cases.

Limb Salvage icon

Limb Salvage

In vascular medicine, limb salvage surgery refers to treatment methods that are used to heal feet and legs that are at risk of amputation, including those affected by severe ulceration, gangrene, tissue loss, or pain from underlying vascular disease. While these symptoms are multifactorial, some form of severe vascular obstruction, either in the arterial system or the venous system, is often a root cause. Many amputations are preventable with modern vascular approaches, so the possibility of limb salvage surgery should always be evaluated before an amputation is prescribed.

 Vascular Wound Care icon

Vascular Wound Care

Non-healing wounds usually form on the back of the lower leg between the calf and ankle, causing itchiness, leg pain, and skin discoloration. While it’s true that these wounds can be caused by injury or other conditions like diabetes, chronic lower extremity wounds that take more than 2 weeks to heal or that lead to progressively worsening skin breakdown are more than likely attributable to underlying vascular disease, and therefore benefit significantly from vascular wound care. In fact, vascular disease contributes to more than 90% of chronic wounds.

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