Arterial hypertension causing leg ulcers

Abstract

We report clinical and histological features of 16 consecutive patients with hypertensive leg ulcers. The lumen/wall ratio in arterioles at the edges of these hypertensive leg ulcers was compared with that in other types of chronic leg ulcers and was found to be significantly reduced (P < 0.001). Additional conditions such as venous hypertension or main vessel arterial disease contributed. Nineteen of 22 ulcers were completely healed after a mean of 4.9 months. Recognition of this condition enables correct treatment choice, which usually involves excision and grafting, and early healing. The classical hypertensive leg ulcer was initially described by Martorell in 19451 and subsequently by others.2–8 As described, it is situated on the lateral aspect of the lower leg above the ankle, is painful, often severely so, and has necrotic edges. Patients have a history of arterial hypertension, although the blood pressure may be normal at presentation. There is usually no surrounding oedema or stasis pigmentation and peripheral vascular disease is absent. The ulcers are often resistant to conservative treatments and most reported cases eventually require excision and grafting or lumbar sympathectomy before healing occurs. Martorell1 emphasized that usually there is no evidence of main vessel arterial disease or a disturbance in the venous circulation. Milder or atypical cases may be misdiagnosed. We studied patients with leg ulcers in which hypertension was considered the main aetiological factor to document features.