It is a common knowledge that in 70 percent cases leg ulcers are caused by disease of veins. The veins of leg are those blood pipes which carry back impure and oxygen-deficient blood accumulated in leg, back to heart and then from there to lung for purification and replenishment with oxygen. But in 25 percent cases of leg ulcers, the cause happens to be the disease of artery. The arteries in the leg are those blood pipes which supply pure and oxygen-rich blood to legs and feet. When these arteries become diseased, the supply of pure blood to legs naturally will be disturbed. This decreased supply of pure blood will lead to leg ulcer and gangrene.
Diseases of Artery giving rise to leg ulcer
The disease of arteries is of various types. Firstly if the wall of the artery has inflammatory swelling, the pure blood flowing through it will start clotting and eventually will block the blood flow. This type of inflammatory swelling of arterial wall is called ‘VASCULITIS’ in medical terms. This vasculitis affects small blood pipes (arteries) like those of toes and fingers in majority of the cases.
The other disease of the artery causing leg ulcer is due to accumulation of fat, calcium and cholesterol inside the artery. This leads to decreased blood supply and sometimes almost no supply. In such situation, even minor injury to foot will result into an ulcer that never heals. Such ulcers will heal completely only after blood supply to feet is restored.
Tobacco-chewing or smoking gives birth to leg ulcer
The third important disease of artery is the BURGER’s disease caused by smoking or tobacco-chewing. In cigarette, Bidi and tobacco products like Khaini, Chaini, Zaafaranipatti, Zarda-Mixed Paan Masaala, Mainpuri is contained a very harmful element called nicotine which causes constriction and narrowing of medium-sized and small arteries. With the result, supply of oxygen-rich pure blood to legs and feet becomes negligible in amount. This causes severe leg pain and later on leg ulcer. If this continues without restoring blood supply, the danger of gangrene looms large.
What to do in such situations?
Without wasting any time, consult an experienced vascular surgeon. Arterial angiography is a very important tool for assessment of leg ulcer caused by disease of artery. In modern days, a new type of angiography called multi-slice C.T. angiography has made the task very easy. This C.T. angiography neither requires indoor hospital stay nor any puncture in groin area and passing of catheter (wire) inside. Above all, this investigation is also cost effective and easy.
Angiography helps in identifying the exact quantum of pure blood supply of leg, extent of blockage and exact status of small collateral blood supply. All these information thus gathered help in formulating exact strategy for treatment
Hospitals suitable for leg ulcer treatment
For correct treatment of leg ulcer caused by disease of artery, always go to a hospital where a full-time vascular surgeon is available. Before entering a hospital also make sure whether facility for special investigations like Doppler study, CT and MR angiography do exist or not. This is also equally important to know whether in that hospital bypass surgery of legs and hands are performed routinely or not.
New Modalities of Treatment
This must be understood very clearly that it is impossible to get ulcer healed without restoring supply of pure blood to leg. Quite frequently, people go to quacks and follow the advice of applying funny creams, ointments and sometimes cow’s urine. This results into worsening of condition of ulcer, not to talk of healing. Therefore, you must avoid visiting a variety of street smart quacks. If vasculitis is the cause of ulcer, generally no active surgical intervention is required in majority of such cases. If blocked artery is the cause, arterial bypass surgery is required whereby artificial imported blood pipes are used. In some conditions, angioplasty or stenting is indicated. If leg starts getting more amount of pure blood and oxygen after restoration of blood supply, the possibility of ulcer healing increases tremendously.
Dr K K Pandey is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi India.