Arteriosclerotic Ulcer of Legs Without Occlusive Arterial Disease

Abstract

Twenty-one patients with arteriosclerotic ulcers of the legs are presented. All had normal blood pressure and had not a diabetic background, varicosities, or arteriosclerosis obliterans of the lower extremities. Histo logic examination is shown to be the best procedure for establishing the correct diagnosis. Changes in small arteries, between 100 and 300 microns in diameter, are characteristic. Two types of lesions were observed in these vessels: type I, consisting of hyperplasia of intima and media; and type II, consisting of enlargement and fibrosis of the intima and media. The type II lesion was found to be useful in separating arteriosclerotic ulcers from hypertensive ones, as well as from diabetic ulcers. The treatment consisted of local surgical resection and grafting. In five cases, because of multiple ulcers and/or severe dysthrophic skin changes, a sympatectomy was also performed.