Vascular Wound Care Specialist in Los Angeles
Dr. Lalezarian, a vascular wound care specialists in Los Angeles, explains the often-missed vascular components of difficult-to-heal lower-extremity wounds, and how minimally invasive vascular interventions can bridge the gap between traditional wound care approaches and complete healing. Learn about arterial wound & venous wound differences, symptoms, treatment, and 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.
Obstructed blood flow is the unifying disease process in many vascular diseases, underpinning peripheral artery disease (PAD) in the arteries, chronic venous insufficiency wounds (CVI) in the veins, and a number of other localized vascular conditions like May-Thurner Syndrome and venous thromboembolism. Throughout the course of several years, these diseases disrupt blood flow to tissues, eventually damaging skin, muscles, and nerves due to lack of adequate blood supply. Over 8.5 million people in the US suffer from PAD and more than 6 million live with CVI [1,2].
Your Partner in Vascular Wound Care & Treatment
Dr. Michael Lalezarian
Timely, accessible wound care is paramount in the effort against arterial wounds, venous wounds, and their complications.
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.
Adrianne S, October 2018
Arterial Wound vs Venous Wound
Causes of Arterial Wounds
Causes of Venous Wounds
Ultimately, CVI results in limited blood flow toward the heart. Without the ability to return blood back to the body’s main circulatory pump, blood pools in the extremities and backs up in the veins. The increased blood volume surpasses the veins’ natural reservoir capacity and exerts increased pressure on the vessels, causing undue stress and eventual failure. As more of the venous system is affected and blood flow is further compromised, skin color changes in the lower leg and wounds form as tissue breaks down. Risk factors for venous wound formation include: older age, sedentary lifestyle, high body mass index, arterial hypertension, deep vein thrombosis, deep vein reflux, and a family history of venous leg wounds .
Signs & Symptoms of Vascular Wounds
Arterial wounds typically develop over bony parts of the foot as well as the heels and toes, past the point of vessel occlusion. These can be shallow or deep skin wounds with or without gangrene. Arterial wounds have well-defined edges and appear to be “punched out.” The center of the wound, the wound base, is pale in color (grey or yellow). Skin surrounding the arterial wound may be red, cold to the touch, shiny, and hairless .
As vein disease increases in severity, constant swelling, fat destruction (lipodermatosclerosis), and skin discoloration and deterioration occur anywhere between the knee and ankle [4, 7-9]. Appearance-wise, the skin surrounding the wound looks shiny, thin, hairless, and hyperpigmented with a brown color. The wound itself has sloping edges, and exudate fluid may ooze from the wound. Venous wounds are shallow and irregularly shaped. Pain is usually less severe compared to arterial wounds unless there is an active infection or excessive swelling.
Vascular Wound Care & Treatments
Treating vascular wounds isn’t just about addressing the visible leg ulcer, but also the underlying disease process that created them in the first place. The root cause of arterial and venous wound formation is vascular disease such as advanced peripheral artery disease and chronic venous insufficiency. However, many lower extremity wounds have a multifactorial set of causes (in addition to vascular disease), and therefore require multiple, simultaneous treatment approaches.
A multidisciplinary team consisting of wound care specialists, podiatrists, physical therapists, primary care physicians, and vascular interventionalists will provide the best care for a patient suffering from venous or arterial leg ulcerations attributable to vessel disease [2-3,10]. Vascular interventionalists include general and vascular surgeons, who are best-suited to treat advanced vessel disease through invasive surgeries. They also include interventional radiologists, who specialize in minimally invasive approaches to improve blood flow.
Arterial Wound Care & Treatments
Lifestyle Changes and Medicine
Arterial Wound Care
Patients who present with open, non healing arterial wounds are typically referred to a wound doctor who will clean the wound routinely and dress it with bandages to prevent infection and promote healing of the skin. Arterial wound dressing changes do not target the underlying arterial disease that causes the wounds, however, arterial wound care is still an essential part of healing and complements other treatments.
Minimally Invasive Revascularization
Your Partner in Vascular Care
Venous Wound Care & Treatments
Venous Wound Care
Patients who present with open, non healing venous wounds are typically referred to a wound care specialist who will clean the wound routinely and dress it with bandages to prevent infection and promote healing of the skin. Changes to the wound dressing for venous leg ulcers do not target the underlying vein disease that causes venous ulceration, however, venous wound care is still an essential part of healing and complements other treatments.
Superficial Vein Closure
Deep Vein Revascularization
Vascular Wound Care Specialist in Los Angeles
At ProVascularMD, we provide minimally invasive wound care, both arterial wound treatment and venous wound treatment. Our vascular and interventional radiologists specialize in revascularization techniques to treat peripheral artery disease, and vein closure treatment for venous insufficiency. Give us a call today to schedule your visit!
Lower Extremity Arterial Disease
 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.
 Shu J, Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379-381.
 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.
 Grey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006;332(7537):347-350.
 Salcrido, R. C. Arterial vs Venous Ulcers: Diagnosis and Treatment: Advances in Skin & Wound Care. 2001;14(3):146-147.
 Dean SM. Cutaneous Manifestations of Chronic Vascular Disease. Progress in Cardiovascular Diseases. 2018;60(6):567-579.
 Foy White-Chu E, Conner-Kerr TA. Overview of guidelines for the prevention and treatment of venous leg ulcers: A US perspective. J Multidiscip Healthc. 2014;7:111-117. doi:10.2147/JMDH.S38616
 Meissner (2016). What is effective care for varicose veins? Phlebology, 31(1_suppl), 80–87.
 Gohel (2018). A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. New England Journal of Medicine, 378(22), 2105–2114.
 Kankam (2017). A summation analysis of compliance and complications of compression hosiery for patients with chronic venous disease or post-thrombotic syndrome. European Journal of Vascular and Endovascular Surgery, 55:406-416.
 Lohr (2010). Radiofrequency Ablation: Evolution of a Treatment. Seminars in Vascular Surgery, 23(2), 90–100.
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