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Identify and Treat the Cause - Optimize Medical Therapy


The two strategies of caring for patients with arterial wounds are to improve circulation and improve oxygenation.

  • Smoking and nicotine cessation

    Barriers to cessation should be addressed at each patient visit
    Educational, pharmacological and behavioral techniques should be utilized

  • Suggest initiating statin therapy
  • Control hypertension
  • Control blood sugar if diabetic
  • Suggest antiplatelet therapy (caution when used with Trental – increased chance of bleeding)
  • Avoid extremes that can impair blood flow and oxygen delivery

    Avoid very hot or very cold contact
    Avoid very tight or very loose fitting clothing and footwear

  • Encourage exercise

    Minimum of 30 minutes/3 times week is recommended

  • Address dehydration

    Can impair blood flow and oxygen delivery

  • Control Pain

    The most effective pain control with arterial ulcers is to improve the blood supply.
    Encourage use of analgesics (pain medication) at regular intervals (eg. every 3-6 hours) instead of taking only as needed

    Recommendations for nociceptive pain (described as sharp, aching or throbbing)
    Non-Opioids – eg. ASA or Acetaminophen
    Mild Opioids – eg. Codeine
    Strong Opioids – eg. Morphine or Oxycodone

    Recommendations for neuropathic pain (described as burning, stinging, shooting, stabbing or hyperesthesia – sensitivity to touch)
    Second generation tricyclic agents – eg. Nortriptyline or Desipramine
    If pain is not relieved try using Gabapentin or Pregabalin

Other recommendations for pain control include:

  • Positioning of leg in a dependent position may increase arterial blood flow
  • Calm patient’s fears (anxioytic may be required)
  • Patient may benefit from the head of their bed being elevated. Caution: protect from pressure
  • Spinal cord stimulation may reduce pain
  • Prostanoids may help with rest pain
  • Amputation may have to be considered for pain control and quality of life issues
Pharmacological Treatment
  1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007;45 Suppl S:S5-67.
  2. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006;47:1239-312.
  3. Weir G.R, Hiske S, Marle J.V, Cronje F.J, Sibbald R.G. Arterial Disease Ulcers, Part 2: Treatment. Advances in Skin and Wound Care: September 2014.
  4. World Health Organization. Cancer pain relief. With a guide to opioid availability. 1996. http://whqlibdoc.who.int/publications/9241544821.pdf.
  5. World Health Organization. Cancer pain relief. With a guide to opioid availability. 1996. http://whqlibdoc.who.int/publications/9241544821.pdf.
  6. Registered Nurses Association of Ontario. Nursing Best Practice Guideline: Integrating Smoking Cessation into Daily Nursing Practice. Revised March 2007.

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