Holloway G A
Ostomy Wound Manage. 1996 Apr;42(3):46-8, 50-1.
Arterial ulcers occur because of inadequate perfusion of skin and subcutaneous tissue at rest. Arterial occlusive disease, common among smokers, diabetics and the elderly, can lead to claudication, rest pain and gangrene, in addition to localized ulceration. Other processes, such as venous stasis, pressure, trauma, and vasculitis, can also cause ischemia. However, a thorough patient history and physical assessment can help discriminate between ischemic ulcers caused by arterial disease and other types of ulcers. The key to the diagnosis of arterial occlusive disease is the patient history. Pain while walking is the most common presenting complaint and can indicate intermittent claudication. Physical assessment should include both a general exam, looking for problems relating to lungs, heart and nervous system, and a focused exam of the affected extremities and arterial pulses. Vascular laboratory findings can also help confirm a diagnosis of arterial ischemic ulceration. The key to treatment is improvement in the vascular perfusion to the affected area. Surgical revascularization is the mainstay of treatment, with some interventional procedures becoming accepted. Medical options, in addition to correction of underlying medical problems, include good wound and supportive care, but pharmaceutical interventions have generally not proven effective, and should be considered only if interventional procedures are not possible. With an adequate blood supply reestablished, most arterial ulcers will progress to healing unless there are complicating factors.
动脉性溃疡是由于静息时皮肤和皮下组织灌注不足所致。动脉闭塞性疾病在吸烟者、糖尿病患者和老年人中较为常见，除了局部溃疡外，还可导致间歇性跛行、静息痛和坏疽。其他过程，如静脉淤滞、压力、创伤和血管炎，也可导致缺血。然而，全面的患者病史和体格检查有助于区分动脉疾病引起的缺血性溃疡和其他类型的溃疡。动脉闭塞性疾病诊断的关键在于患者病史。行走时疼痛是最常见的主诉，可提示间歇性跛行。体格检查应包括全面检查，寻找与肺、心脏和神经系统相关的问题，以及对受影响肢体和动脉搏动的重点检查。血管实验室检查结果也有助于确诊动脉缺血性溃疡。治疗的关键是改善受影响区域的血管灌注。手术血管重建是主要的治疗方法，一些介入手术也逐渐被接受。除了纠正潜在的医疗问题外，药物治疗选择包括良好的伤口护理和支持性护理，但药物干预一般未被证明有效，仅在无法进行介入手术时才应考虑。在重新建立充足的血液供应后，除非存在复杂因素，大多数动脉性溃疡将逐渐愈合。
