Arterial Leg Ulcers

Arterial ulcers are a common cause of skin necrosis on the leg and are usually a consequence of peripheral arterial occlusive disease (PAOD). They can also occur in combination with the most common cause of leg ulcers, chronic venous insufficiency, as mixed arterial-venous ulcers. They are usually considered as a complicated “stage IIB of PAOD.” The most common localization of arterial ulcers is the lateral and pretibial aspect of the lower leg, whereas the skin necrosis of PAOD stag IV is located on the distal foot and toes. They are typically painful. Diagnostic workup includes Doppler measurement of ankle-brachial index (ABI) and, in case of mediacalcinosis, also measurement of toe systolic pressure and tcpO2. Gold standard for localization of arterial occlusion is angiography. Treatment is based on interventional or surgical revascularization, supplemented by best-practice local wound care. Arterial ulcers are often very recalcitrant, and advanced wound healing methods such as tissue-engineered products or skin grafts are used in many cases.