An ischemic ulcer is a chronic wound that occurs due to a lack of blood supply in an area of the body, such as the legs. They usually affect older adults and people with certain health conditions.
The ulcers develop when the tissues of the skin do not receive enough oxygen and nutrients due to restricted blood flow. This occurs due to conditions that affect circulation, such as peripheral artery disease (PAD) or diabetes.
This article explores ischemic ulcers and provides an overview of their symptoms, causes, and treatments.
An ischemic ulcer is a type of wound or sore that develops when the arteries do not deliver enough blood flow to a specific area.
This lack of blood results in a decreased oxygen and nutrient supply to tissues, causing damage and cell death, or necrosis. This, in turn, can lead to the formation of painful ulcers that are slow to heal or may not heal at all.
Ischemic ulcers most commonly affect the lower limbs, particularly the feet and toes. These areas are the farthest from the heart and are therefore more vulnerable to reduced blood flow due to circulation problems.
The lower legs are also prone to swelling and pressure, which can further compromise blood flow and contribute to the development of ischemic ulcers.
While ischemic ulcers are primarily a skin condition, they can also affect internal organs, such as the colon. Ischemic colitis is a condition that occurs due to reduced blood flow to the colon, leading to inflammation and ulceration of the intestinal lining.
Venous and arterial ulcers are both types of ischemic ulcers, which describes ulcers that occur due to a lack of blood flow in general. However, venous ulcers occur specifically due to problems with veins, while arterial ulcers occur due to problems with arteries.
Venous ulcers are typically shallow, have an irregular shape, and appear near bony parts of the body, such as the ankle. They are the most common type of chronic ulcer on the legs.
In contrast, ischemic ulcers are often symmetrical in shape with defined borders. They frequently appear on the tops of the feet or toes and the lower legs.
Narrowed arteries and reduced blood flow, which doctors call ischemia, cause ischemic ulcers. Several conditions can lead to this, including:
- PAD, which
can be a complication of diabetes, hypertension, and hyperlipidemia - atherosclerosis
- heart disease
- cerebrovascular disease
- blood clotting disorders
- venous insufficiency
Risk factors that elevate the chances a person will develop ischemic ulcers include:
- smoking
- higher body mass index
- a family history of conditions that cause ulcers
- joint or skeletal disease in the lower limbs
- physical inactivity
Symptoms of ischemic ulcers include:
- deep, open wounds on the legs, ankles, or feet
- dark red, yellow, gray, or black sores that do not bleed
- ulcers having a punched appearance with well-defined borders
- pain and discomfort, especially at night
- surrounding skin appears shiny, tight, dry, and hairless
- faint or absent ankle pulses
Diagnosing ischemic ulcers
Tests to assess blood flow, blockages, and tissue damage can support the doctor’s diagnosis. These may include:
- capillary refill time, which involves compressing the skin and measuring how long it takes to refill with blood
- a Buerger test, which involves elevating the leg to see if the foot turns pale
- a Doppler ultrasound, which uses sound waves to measure blood flow in the affected area
- transcutaneous oximetry, which measures oxygen supply around the wound
- angiography, which is an imaging test that uses a special dye and X-rays to create detailed images of the blood vessels
If the underlying cause of the reduced blood flow is not clear, the doctor may also order tests to determine what the root cause of the ulcer is.
Treatment for ischemic ulcers varies depending on the case but typically includes:
- wound care
- medications
- lifestyle changes
For example, if a person has diabetes, their treatment plan may include strategies to keep the ulcer clean and protected, medications to control blood sugar, and changes to their diet.
In some cases, doctors may recommend procedures to improve blood flow to the affected area. One of these procedures is angioplasty, a minimally invasive procedure where a surgeon inserts a balloon into a blocked or narrowed artery using a catheter.
The surgeon inflates the balloon to widen the blood vessel. They may insert a stent, which is a tiny metal mesh tube, to keep it open.
Bypass surgery is a more invasive procedure that involves creating a new path for blood to flow around a blocked or narrowed artery.
During this procedure, a surgeon takes a healthy blood vessel from another part of the body, such as the leg or chest, and grafts it onto the affected artery. This new vessel bypasses the blocked or narrowed area, allowing blood to flow freely.
Regular follow-up appointments may be necessary to monitor the healing process and adjust the treatment plan as necessary.
Ischemic ulcers are chronic wounds that occur due to reduced blood flow to a specific part of the body, such as the lower limbs. Various health conditions that affect circulation can contribute to their development.
Diagnosis involves a physical exam and various tests, such as Doppler ultrasound. Treatment begins by addressing the underlying cause and may involve wound care, medication, lifestyle changes, and procedures to restore blood flow.