Clinical meaning
Arterial ulcers result from peripheral arterial disease (PAD), where atherosclerotic narrowing of arteries reduces blood flow to the lower extremities causing tissue ischemia. Without adequate arterial supply, tissue oxygen delivery falls below the metabolic threshold, leading to cell death and ulcer formation. Arterial ulcers differ significantly from venous ulcers: they occur on the toes, dorsum of the foot, lateral malleolus, or between toes (pressure points and areas most distal from the heart). They have well-defined, punched-out borders with a pale, dry wound bed lacking granulation tissue. The surrounding skin is shiny, hairless, and cool with thickened nails. Patients experience intermittent claudication (calf pain with walking that resolves with rest) progressing to rest pain (constant ischemic pain, worse at night, relieved by dangling legs). ABI < 0.9 indicates PAD; ABI < 0.4 indicates severe ischemia with critical limb ischemia. Compression therapy is CONTRAINDICATED in arterial ulcers as it further reduces already compromised blood flow.
Exam relevance
Risk factors: - Smoking - strongest modifiable risk factor for PAD - Diabetes mellitus accelerating atherosclerosis - Hyperlipidemia and hypertension promoting plaque formation - Advanced age > 60 years - History of cardiovascular disease (coronary or cerebrovascular)