Úlceras en la pierna: venosas vs. arteriales (y cuándo actuar urgente)

·15 min·1 clip

A vascular surgeon explains why your body is like a house with clogged pipes and a failing sewer system.

1. Ciudad Médica podcast, produced by Hospital Bozán de Quito and HCJB, devotes this episode to understanding venous versus arterial leg ulcers and knowing when each requires urgent intervention. 2. The guest is Dr. Donovan Ruiz, a vascular surgeon at Hospital Bozán de Quito who specializes in venous and arterial disease and has performed complex endovascular procedures. 3. The episode's central argument is that a leg wound that won't heal is rarely 'just a skin problem' — it signals an underlying vascular condition that, if left untreated, can lead to amputation or death. 4. Dr. Ruiz introduces the plumbing metaphor: the heart is the pump, arteries are the fresh-water supply lines carrying oxygenated blood to the tips of the toes, and veins are the drainage system that must fight gravity to return blood to the heart. 5. Venous insufficiency occurs when the venous return is impaired by risk factors including heredity, obesity, prolonged standing or sitting, and sedentary lifestyle — causing blood to pool, producing pain, heaviness, cramps, and eventually chronic wounds. 6. Arterial insufficiency is the opposite failure: the supply line is blocked, blood does not reach the tissue, and the tissue becomes ischemic, turns dark, and dies — and no dressing or cream can reverse this without restoring flow. 7. The critical clinical rule he states is: 'no existe poder humano que logre cicatrizar esa herida' — no human effort can close an arterial ulcer — unless blood supply is restored through surgery or endovascular intervention. 8. Minimally invasive endovascular options include catheter-based thrombectomy (clot extraction), balloon angioplasty (dilating the artery), and stent placement to maintain an open channel for blood flow. 9. The case of an 86-year-old patient is described in detail: she arrived with a toe ulcer, intense limb pain, no palpable pulses, and arterial plaques throughout the leg with a distal thrombus — her family had been told she needed above-knee amputation. 10. After referral to Dr. Ruiz, a plan was developed to attempt endovascular thrombectomy: via a groin puncture, all thrombus was extracted, and the arterial channel was dilated with balloons to restore full-limb blood flow. 11. The outcome was limb salvage; the patient, who turned 87 the month of the interview, kept her leg — and Ruiz emphasizes this required a multidisciplinary team including internists, endocrinologists, and geriatricians. 12. Post-procedure cardiovascular protection was established to prevent re-thrombosis, illustrating that the procedure is only one component of ongoing vascular management. 13. On diagnosis: Ruiz explains that clinically distinguishing venous from arterial ulcers begins with palpating two foot arteries — the dorsal pedis at the top of the foot and the tibial at the inner ankle — a physical exam that rules out arterial compromise with 90% confidence. 14. Venous ulcers are characterized by high exudate volume, irregular borders, skin color changes, possible varicose veins, and no absent pulses; arterial ulcers by dark, necrotic tissue, severe pain, and absent foot pulses. 15. Infected venous ulcers present with the classic signs: redness, heat, swelling, pain — but an infected wound in a patient over 75 may show none of these, presenting instead as appetite loss or altered consciousness. 16. A colleague's case is described where an elderly patient's leg was found on examination to have crepitance — air in the tissues — and the entire limb was filled with pus, requiring fasciotomies (surgical opening of the leg compartment) to save the extremity. 17. Risk factors that should prompt a vascular surgery referral include: family history of leg ulcers or varicose veins, current or past smoking, diabetes, hypertension, and high cholesterol — all of which accelerate arterial wall thickening and obstruction. 18. The tone is conversational and deeply human, with Ruiz describing his philosophy of becoming part of the patient's family through the course of treatment — a value explicitly aligned with Hospital Bozán de Quito's stated ethos. 19. People over 60 with any vascular risk factors, or family members caring for elderly patients with leg wounds that won't heal, will find this episode directly actionable. 20. Listeners seeking detailed guidance on wound-dressing techniques, post-operative rehabilitation, or compression therapy protocols will need to consult specialist resources beyond this episode.

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