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Ischemic ulcer
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Ischemic ulcer

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Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Ischemic (or arterial) ulcers are a type of vascular ulcer that occurs when there is inadequate blood supply to the skin. They are most frequently caused by progressive atherosclerosis (peripheral vascular disease) or arterial embolization. They predominantly involve the feet but, occasionally, can be seen with upper extremity occlusive disease such as thoracic outlet syndrome or Raynaud phenomenon.

Ischemic ulcers are often chronic in nature and are characteristically quite painful relative to other types of ulcers. Their occurrence may be precipitated by seemingly trivial trauma or localized pressure. The incidence of ischemic ulcers increases with advancing age; older individuals are also more likely to exhibit ulcers of mixed etiology. Patients with ischemic ulcers due to peripheral vascular disease will often give a history of claudication. Risk factors for the development of these ulcers include diabetes mellitus, smoking, hyperlipidemia, obesity, rheumatoid arthritis, a history of coronary artery disease, and hypertension. Martorell ulcer occurs in the setting of poorly controlled hypertension. Many patients have associated diabetes mellitus. Typically, there is an intensely painful ulcer on the inferior calf or over the Achilles tendon. Ischemia is thought to be a factor in its development.

Critical limb ischemia (CLI) is defined by the presence of longer than 2 weeks of limb pain at rest from ischemia, tissue loss due to ischemia, or ischemic ulceration. Clinicians of all types must be aware of the need for rapid revascularization, modifications in medical therapy, and wound care to minimize loss of limbs and loss of life in these patients.

Codes

ICD10CM:
I83.009 – Varicose veins of unspecified lower extremity with ulcer of unspecified site

SNOMEDCT:
13954005 – Ischemic ulcer

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis includes other disease processes in which ulceration is a prominent feature:

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Management Pearls

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Therapy

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References

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Last Updated: 05/13/2019
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Ischemic ulcer
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Ischemic ulcer : Claudication, Cyanosis, Eschar, Leg pain, Painful skin lesions, Skin ulcer, Feet
Clinical image of Ischemic ulcer
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