Peripheral vascular disease and stasis ulcers: treatment from a naturopathic perspective

Townsend Letter for Doctors and Patients,  August-Sept, 2003  by Jason Barker,  Chris D. Meletis

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Peripheral vascular disease most often refers to a disease condition of the blood vessels outside of the heart and brain, from which 2 million Americans suffer, and is a leading cause of amputations in the United States. Peripheral vascular disease (PVD) occurs in two general types: Functional, which has no single identifiable cause and is not usually related to defects in the structure of the blood vessels, (an example is Raynaud's disease) and Organic PVD, which is caused by structural changes to the blood vessels themselves from pathologic inflammatory processes and tissue damage. (An example of this is atherosclerosis). Atherosclerosis results from the accumulation of a combination of fatty material and cellular debris that can coat the inside of blood vessels, restricting blood flow to the limbs of the body. Often, symptoms of atherosclerosis do not appear until nearly 75% of the artery is occluded, leaving people unaware of the disease process of peripheral vascular disease. There are many predisposing factors, signs and symptoms that indicate an increased chance of suffering from the effects of peripheral vascular disease, such as:

* High blood pressure

* Diabetes

* Family history or immediate family members with diabetes or other cardiovascular problems (stroke, hypertension, myocardial infarction)

* Aching or cramping in the legs while exercising that resolves upon rest

* Pain in toes or feet at night

* Slow healing wounds

* Current or past cigarette smoker

* Overweight

* Consumption of fried/fatty foods on a regular basis

* Inactive lifestyle (lack of exercise)

The causes of peripheral vascular disease are numerous and well documented, with many controllable risk factors. As a subset of cardiovascular disease, these conditions that affect the vascular system represent one of the largest health issues in recent history.

In the year 2000, nearly 61,800,000 Americans had one or more types of cardiovascular diseases. (1) Although Americans are among the most-affected citizenry of the world, this problem is not limited to the United States, as the inhabitants of mainly modernized countries throughout the world share in this public health crisis.

Stasis Ulcers

One effect of peripheral vascular disease is stasis ulcers, which are leg ulcerations that develop from cessation or impairment of venous flow through the limb. Chronic venous leg ulcers are a major health problem, affecting principally the elderly. The natural history of the disease involves a continuous cycle of healing and breakdown over decades and recurrence is common. Often, a small abrasion or other injury will precipitate the formation of an ulcer, which can last from months to years if left untreated. Chronic venous stasis ulcers affect approximately 500,000 people each year in the US, with significant effects on quality of life and medical expenses. A study designed to discover the medical costs of stasis ulcers (which account for approximately 80-90% of lower extremity ulcerations) in routine clinical practice, determined the average total medical cost per patient was $9685 (median: $3036). (2) This study also noted that missed work, early retirement, loss of physical independence and suffering were not factored into the monetary costs of this condition.

Venous stasis occurs most commonly in patients with congestive heart failure, diabetes, or obesity. The simultaneous appearance of these diseases and conditions are no surprise, as all negatively affect the cardiovascular system, setting it up for various disease conditions, and all are attributable to the increasing girth and concomitant poor health status of the US population. Typical signs of developing chronic venous insufficiency include edema of the foot, enlarged varicose veins, and skin hyperpigmentation. Stasis ulcers occur most often just above the medial mallelous, but may be located on any part of the lower leg. The ulcer site is often painful and the leg swollen. Stasis ulcers are the end result of sustained venous high pressure that damages capillaries, allowing them to become more permeable. Elevating pressure combined with stagnant blood flow in the lower leg allows blood proteins to leak into the surrounding tissues, initiating the breakdown process of the tissue, finally leading to ulceration of the overlying tissues.

Other diagnostic possibilities include ulcers less commonly caused from arterial insufficiency, vasculitis, or skin malignancies. Measurement of arterial blood pressure and Doppler ultrasound are used to assess for arterial insufficiency. A biopsy of the ulcer can differentiate skin malignancy from vasculitis. Venous stasis ulcers are recalcitrant to healing, necessitating a multifactorial approach. Standard medical treatment for venous stasis involves a focus on dressing systems to direct the wound healing process itself, and do not typically factor in the underlying cause or nutritional approaches to expedite the healing process.

Treating the Cause