Treatment

• treatment is symptomatic
  • rest and warmth are important
  • sympathetic vasodilators may provide pain relief
  • lumbar sympathectomy e.g. with an injection of phenol, may be indicated, and on occasion a nerve block may be used
• systemic antibiotics may be required if there is cellulitis
• revascularization procedures, resulting in blood flow restoration can lead to ulcer healing in patients with arterial insufficiency ulcers
  • reconstructive surgery (for diffuse disease) or angioplasty (for localised stenosis) can be used
  • operative indications for chronic ischemia include - non-healing ulceration, gangrene, rest pain, and progression of disabling claudication (1)
• risk factor reduction may prove helpful in reducing the risk of arterial ulcer development and recurrence. It involves cessation of cigarette smoking as well as control of other risk factors that may be present such diabetes mellitus, hyperlipidaemia, and hypertension (1)

Reference:

• (1) Hopf HW, Ueno C, Aslam R, Burnand K, Fife C, Grant L, Holloway A, Iafrati MD, Mani R, Misare B, Rosen N, Shapshak D, Slade JB, West J, Barbul A. Guidelines for the treatment of arterial insufficiency ulcers. Wound Rep Reg 2006; 14: 693-710
• (2) Grey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006;332(7537):347-50.