Managing Venous and Arterial Ulcers: What Long-Term Care Teams Need to Know

Important note: The following information is for educational purposes only and is not a substitute for clinical judgment or medical advice. Always consult a qualified healthcare professional for assessment and treatment decisions.

Long-term care teams frequently encounter venous leg ulcers (VLUs) and arterial ulcers: two distinct conditions with differing etiologies, treatment protocols, and risks. VLUs, driven by chronic venous hypertension, account for up to 80% of lower-extremity ulcerations and affect ~1% of the U.S. population. They often develop near the ankle, have slow healing rates, and carry a high risk of recurrence.

Arterial ulcers arise from inadequate arterial perfusion, most commonly due to peripheral arterial disease (PAD), and can deteriorate rapidly without restoration of blood flow. For quick reference, the table compares venous and arterial ulcers across key clinical features.

AttributeVenous Leg Ulcer (VLU)Arterial Ulcer
Location — Where the Ulcer AppearsAround inner ankle/lower leg (gaiter area)Toes, feet, outer ankle; pressure points
Ulcer Appearance — What It Looks LikeShallow, irregular edges; red base ± sloughDeep, punched-out, pale or black base; clear edges
Surrounding Skin (Periwound)Brown staining, thickened skin, swelling commonCool, pale or bluish skin; shiny, hairless; poor capillary refill
Pain PatternMild to aching; often better when elevatedSevere; worse when elevated, relieved when dangling
Drainage (Exudate)Moderate to heavy exudate (wound often appears wet)Minimal; usually dry or with scab/eschar
Circulation Signs (Perfusion)Foot pulses present; warm skin; normal refillPulses weak/absent; cold skin; delayed refill
Essential Diagnostic ChecksABI to assess blood flow; vein ultrasoundABI (often low); arterial imaging for blockages
Core Treatment ApproachCompression, wound care, leg elevation; address veinsRestore circulation (e.g., angioplasty); protect wound; manage risk factors
Compression Safety (ABI-guided)Safe if ABI ≥ 0.8Light compression if 0.5–0.79 (specialist)Avoid if ABI < 0.5 or > 1.3Unsafe if ABI < 0.5Only with specialist advice if mixed ulcer
Healing OutlookGood with compression; recurrence common if not maintainedPoor without revascularization; may lead to complications if untreated

Evidence-based management of venous ulcers

Compression therapy is the cornerstone of VLU care. Graduated compression reduces venous hypertension, promotes venous return, and improves healing; leg elevation about 30 minutes, three to four times daily, further reduces edema. Compression can be delivered via multilayer bandaging or compression stockings, chosen to fit resident factors and staff workflow.

Pharmacologic adjuncts:

  • Pentoxifylline, when added to compression, improves healing rates. Benefits are also seen (to a lesser extent) when compression cannot be used.
  • Aspirin as an adjunct has insufficient and inconsistent evidence. Systematic reviews note small trials with mixed results and conclude that benefits and harms remain uncertain.

Addressing superficial venous reflux: In large, chronic, or recurrent VLUs, guidelines support interventions to treat superficial venous reflux (e.g., endovenous ablation) in addition to compression to improve healing and reduce recurrence.

Arterial ulcers: Timely identification and intervention

In contrast to VLUs, standard/high-pressure compression is contraindicated in severe arterial disease. Consensus statements specify that ABPI < 0.6 is a contraindication to compression. Initial management focuses on vascular assessment (pedal pulses, ABPI) and, when indicated, more advanced testing.

For mixed disease (suspected venous disease with mild-to-moderate arterial involvement), guidance varies. Some guidelines allow modified, lower-pressure compression in the ABPI 0.5–0.8 range, but emphasize specialist oversight and careful monitoring. Overall, there is no global consensus for this ABPI band.

For arterial ulcers and chronic limb-threatening ischemia (CLTI), revascularization is the primary therapeutic goal to minimize tissue loss, relieve pain, and enable wound healing. Compression should be avoided in severe ischemia.

Leveraging mobile, AI-enhanced wound care

In long-term care, consistent, objective measurement can be challenging. AI-enhanced imaging tools can provide reliable, repeatable measurements of wound size/area and tissue composition, improving documentation and trend tracking over time. These technologies do not replace vascular assessment for determining etiology but can standardize serial measurements, support care planning, and streamline communication among teams.

Conclusion

Effective management of venous and arterial ulcers in long-term care starts with accurate diagnosis and stratification, followed by evidence-based therapies and ongoing monitoring.

  • For VLUs: Prioritize compression and elevation, consider pentoxifylline as an adjunct when appropriate, and address superficial venous reflux to reduce recurrence.
  • For arterial ulcers/CLTI: Prompt vascular evaluation and revascularization are central. Avoid compression where ischemia is severe.
  • Across etiologies, structured assessment and objective measurement improve consistency and documentation in busy SNF/ALF environments.

Learn more about how we support Skilled Nursing and Assisted Living communities across Greater Sacramento with AI-supported wound care and predictive monitoring.

References

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