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Therapeutics in Dermatology
A reference textbook in dermatology
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Arterial ulcers

18 March 2014, by BROUILLARD C. & TRUCHETET F.

Arterial ulcers are common and affect at least 1% of elderly subjects over the age of 65 years. The great majority of ulcers are venous ulcers while arterial and mixed ulcers account for respectively 10 and 30% of cases with an increase in the proportion of mixed ulcers being observed [1].

The great majority of arterial ulcers are related to chronic peripheral artery occlusive disease (PAOD) with the two main causes being atherosclerosis and diabetic angiopathy.

Peripheral artery occlusive disease is just the specific expression of diffuse atherosclerosis (coronary heart disease, cerebral arteriopathy, ...). The disease must be taken into account as a global entity in order to assess the risk of surgery and active therapy on arterial insufficiency. The mortality of patients presenting with PAOD is similar to those presenting with ischemic heart disease. They should therefore benefit from the same level of attention.

Numerous risk factors exist for cardiovascular disease. They should be identified and controlled:

– age: the prevalence of PAOD increases with increasing age. After 80, 50 per cent of patients with leg ulcers present with PAOD;

– smoking;

– diabetes, with the objective of maintaining a glycated haemoglobin value of 7 per cent [2];

– dyslipidemia;

– hypertension;

– obesity and sedentariness.

The social situation of the patient must be assessed as it can impact the patient’s compliance with treatment.

A comprehensive geriatric assessment is required at the slightest sign of loss of autonomy in elderly subjects with leg ulcers.

Analgesics are the mainstay of management strategy for all ulcers, particularly arterial ulcers. The times of the day pain is experienced and pain intensity should be taken into account and analgesic doses should be increased progressively in a stepwise fashion while monitoring patients for signs of intolerance, particularly elderly subjects.

Therapeutic management of the disease is often multidisciplinary and patients are most often treated in a hospital setting.

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