Arterial Leg Ulcers

Leg ulcers are not a diagnosis but a symptom of many different diseases. In this chapter we will describe leg ulcers caused by arterial disease. However, many other causes should be considered in refractory ulceration on the lower extremity such as venous disease, neuropathy, and miscellaneous causes like vasculitis, malignancy, and autoimmune disease and even rare causes like pyoderma gangrenosum [1], thromboangiitis obliterans, or arterial-venous malformation. Martorell hypertensive ischemic leg ulcers [2] as part of the arterial causes are not discussed here as they are described in another chapter. Very often the ulcers of the lower leg result from a combination of factors [3]. Therefore, it is important to rule out arterial insufficiency even when other causes or clinical signs are present. For example, about 15 % of all leg ulcers are of a mixed arterial-venous origin [4, 5]. We postulate that every patient with ulceration on the lower leg should receive an arterial workup, not only because a concomitant arterial disease may delay healing but also because of the underlying systemic process (arteriosclerosis) for which the patient might profit by an appropriate systemic therapy [6, 7].