Venous and arterial leg ulcers: differential diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"L'ulc\u00e8re de jambe veineux r\u00e9sulte d'une insuffisance veineuse chronique et l'ulc\u00e8re art\u00e9riel d'une isch\u00e9mie. 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famille<\/span>\n <h1>Ulc\u00e8re de jambe veineux et art\u00e9riel<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Les ulc\u00e8res de jambe constituent une plaie chronique \u2014 d\u00e9finie par une perte de substance cutan\u00e9e ne cicatrisant pas spontan\u00e9ment en moins de 6 semaines malgr\u00e9 un traitement appropri\u00e9 \u2014 de la jambe ou du pied + repr\u00e9sentant un probl\u00e8me de sant\u00e9 fr\u00e9quent et invalidant qui touche 1 \u00e0 2 % de la population adulte dans les pays d\u00e9velopp\u00e9s + avec une pr\u00e9valence atteignant 3 \u00e0 5 % chez les personnes de plus de 65 ans. La cause la plus fr\u00e9quente est l'insuffisance veineuse chronique (ulc\u00e8re veineux \u2014 70\u201380 % des cas) + suivie de l'art\u00e9riopathie oblit\u00e9rante des membres inf\u00e9rieurs (ulc\u00e8re art\u00e9riel ou isch\u00e9mique \u2014 10\u201315 % des cas) + des ulc\u00e8res mixtes (art\u00e9rio-veineux \u2014 10\u201315 %) + et des causes moins fr\u00e9quentes (ulc\u00e8re diab\u00e9tique neuropathique + ulc\u00e8re de pression + vascularite + pyoderma gangrenosum + n\u00e9oplasique). La distinction entre ulc\u00e8re veineux et art\u00e9riel est fondamentale et urgente en pratique clinique \u2014 car leurs traitements sont radicalement oppos\u00e9s : la compression veineuse \u00e0 forte pression (bandage + bas de compression) est le pilier du traitement de l'ulc\u00e8re veineux + mais elle est absolument contre-indiqu\u00e9e dans l'ulc\u00e8re art\u00e9riel (la compression aggrave l'isch\u00e9mie et peut pr\u00e9cipiter une gangr\u00e8ne) \u2192 mesurer syst\u00e9matiquement l'index de pression systolique (IPS) avant toute compression. L'\u00e9valuation de l'IPS par Doppler de cheville est donc l'examen cl\u00e9 qui conditionne la prise en charge : IPS \u2265 0,8 = composante art\u00e9rielle absente ou mineure \u2192 compression possible + IPS < 0,6 = isch\u00e9mie s\u00e9v\u00e8re \u2192 compression contre-indiqu\u00e9e \u2192 revascularisation urgente.\n <\/div>\n\n <h2>Diagnostic diff\u00e9rentiel \u2014 caract\u00e9ristiques comparatives<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Characteristic<\/th>\n <th>Ulc\u00e8re veineux<\/th>\n <th>Arterial ulcer<\/th>\n <th>Ulc\u00e8re mixte<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Location<\/td>\n <td>R\u00e9gion mall\u00e9olaire interne (\u00abgu\u00eatre\u00bb) ++ + mall\u00e9ole interne et externe + tiers inf\u00e9rieur de la jambe<\/td>\n <td>Toes + heels + pressure areas + between toes + distal and acromial areas<\/td>\n <td>Variable \u2014 peut \u00eatre atypique<\/td>\n <\/tr>\n <tr>\n <td>Wound appearance<\/td>\n <td>Bords irr\u00e9guliers + fond rouge + ros\u00e9 + exsudatif + bordure hyperpigment\u00e9e (dermite ocre) + induration p\u00e9riulc\u00e9reuse<\/td>\n <td>Bords nets + \u00abperforant\u00bb + fond p\u00e2le ou noir\u00e2tre + n\u00e9crotique + peu ou pas d'exsudat + entour\u00e9 de peau fine + froide<\/td>\n <td>Mixed aspects<\/td>\n <\/tr>\n <tr>\n <td>Pain<\/td>\n <td>Mod\u00e9r\u00e9e + soulag\u00e9e par la sur\u00e9l\u00e9vation et la marche + aggrav\u00e9e en position d\u00e9clive (jambes pendantes)<\/td>\n <td>Intense + lancinante + aggrav\u00e9e par la sur\u00e9l\u00e9vation + soulag\u00e9e en position d\u00e9clive (jambes pendantes = position antalgique) + claudication<\/td>\n <td>Varies according to dominant component<\/td>\n <\/tr>\n <tr>\n <td>Pouls p\u00e9riph\u00e9riques<\/td>\n <td>Pr\u00e9sents (parfois masqu\u00e9s par l'\u0153d\u00e8me) + IPS normal \u2265 0,9<\/td>\n <td>Absents ou diminu\u00e9s + IPS < 0,8<\/td>\n <td>Diminu\u00e9s + IPS 0,5\u20130,8<\/td>\n <\/tr>\n <tr>\n <td>Peau p\u00e9ri-ulc\u00e9reuse<\/td>\n <td>Lipodermatoscl\u00e9rose + hyperpigmentation (dermite ocre = d\u00e9p\u00f4ts d'h\u00e9mosid\u00e9rine) + varices visibles + corona phlebectatica + ecz\u00e9ma veineux<\/td>\n <td>Peau froide + lisse + d\u00e9pil\u00e9e + blanche ou marbr\u00e9e + cyanose des orteils + ongles \u00e9pais<\/td>\n <td>Mixed<\/td>\n <\/tr>\n <tr>\n <td>Contributing factors<\/td>\n <td>Ant\u00e9c\u00e9dent de TVP + varices + ob\u00e9sit\u00e9 + s\u00e9dentarit\u00e9 + profession debout<\/td>\n <td>Tabagisme + HTA + diab\u00e8te + dyslipid\u00e9mie + ATCD coronarien ou AVC (ath\u00e9roscl\u00e9rose)<\/td>\n <td>Combining the two<\/td>\n <\/tr>\n <tr>\n <td>IPS (systolic pressure index)<\/td>\n <td>\u2265 0,9 (normal)<\/td>\n <td>< 0,6 (isch\u00e9mie s\u00e9v\u00e8re) ou 0,6\u20130,8 (isch\u00e9mie mod\u00e9r\u00e9e)<\/td>\n <td>0,5\u20130,8<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Index de pression systolique (IPS) \u2014 mesure indispensable<\/h2>\n <ul class=\"co-list\">\n <li><strong>Technology:<\/strong> ratio of systolic arterial pressure measured at the ankle (by Doppler) to systolic arterial pressure at the arm \u2192 IPS = Ankle BP \/ Arm BP<\/li>\n <li><strong>Interpr\u00e9tation :<\/strong> IPS \u2265 0,9 = normal + IPS 0,7\u20130,9 = isch\u00e9mie l\u00e9g\u00e8re + IPS 0,4\u20130,7 = isch\u00e9mie mod\u00e9r\u00e9e + IPS < 0,4 = isch\u00e9mie s\u00e9v\u00e8re (douleur de repos + risque d'amputation) + IPS > 1,3 = m\u00e9diacalcose (art\u00e8res incompressibles \u2014 diab\u00e8te + IRC + surestimation de la pression) \u2192 utiliser la pression digital ou le TcPO\u2082 dans ce cas<\/li>\n <li><strong>Compression thresholds :<\/strong> IPS \u2265 0,8 \u2192 compression \u00e0 forte pression autoris\u00e9e (40 mmHg) + IPS 0,6\u20130,8 \u2192 compression l\u00e9g\u00e8re possible (20\u201330 mmHg) sous supervision + IPS < 0,6 \u2192 compression CONTRE-INDIQU\u00c9E \u2192 r\u00e9f\u00e9rence vasculaire urgente<\/li>\n <\/ul>\n\n <h2>Traitement de l'ulc\u00e8re veineux<\/h2>\n <ul class=\"co-list\">\n <li><strong>Venous compression (mainstay of treatment) :<\/strong> multi-layer bandage (4 layers - Profore\u00ae + or equivalent) or short elasticity bandage - ankle pressure 35-45 mmHg + reduction in venous hypertension + improvement in venous return + healing rate at 12 weeks: 65-75 % under compression vs 20-25 % without compression + after healing: class II-III compression stockings for life to prevent recurrences<\/li>\n <li><strong>D\u00e9tersion et nettoyage de la plaie :<\/strong> mechanical debridement (curette + scalpel) + or enzymatic + or autolytic (hydrocolloid dressings) \u2192 remove necrotic tissue + biofilm + fibrin \u2192 promote budding<\/li>\n <li><strong>Dressings :<\/strong> choose according to the level of exudate + hydrocolloid dressings (moderate exudate) + silver dressings (if superinfection) + foams (abundant exudate) + interfaces (fragile wounds) + never occlude a superinfected wound \u2192 change 1-3 \u00d7 \/ week according to exudate<\/li>\n <li><strong>Venous surgery :<\/strong> treatment of underlying varicose veins (stripping + laser + sclerotherapy + EVLA) \u2192 reduces the risk of recurrence \u2192 to be considered after healing + or in parallel if varicose veins are severe<\/li>\n <li><strong>Greffe cutan\u00e9e :<\/strong> split-thickness skin graft + or keratinocyte graft + or skin substitutes \u2192 for large + chronic + non-healing ulcers despite optimal compression \u00d7 12 weeks<\/li>\n <li><strong>Pentoxifylline (Trental\u00ae) :<\/strong> 400 mg \u00d7 3\/d per os \u2192 improves microcirculation + reduces vascular inflammation + modest efficacy on healing in addition to compression<\/li>\n <\/ul>\n\n <h2>Traitement de l'ulc\u00e8re art\u00e9riel<\/h2>\n <ul class=\"co-list\">\n <li><strong>Revascularisation (traitement \u00e9tiologique) :<\/strong> percutaneous transluminal angioplasty (PTA) + or bypass surgery (prosthetic + or venous) + depending on location and extent of arterial lesions \u2192 objective: restore sufficient perfusion to allow healing<\/li>\n <li><strong>Traitement m\u00e9dical de l'ath\u00e9roscl\u00e9rose :<\/strong> statins + ACE inhibitors or ARB II + antiaggregants (aspirin + or clopidogrel) + strict blood pressure control + smoking cessation (essential) + diabetes control + progressive therapeutic walking (if GPI \u2265 0.5)<\/li>\n <li><strong>Soins locaux \u2014 plaie art\u00e9rielle :<\/strong> NON-occlusive dressings + dry maintenance of stable dry necrosis (protection) \u2192 do not debride dry necrosis without prior revascularization \u2192 moisten dressings + avoid maceration + delicate care<\/li>\n <li><strong>Compression CONTRE-INDIQU\u00c9E si IPS < 0,6 :<\/strong> worsens ischemia + risk of gangrene + amputation<\/li>\n <li><strong>Amputation:<\/strong> if irreversible ischemia + extensive dry or wet gangrene + osteoarticular infection (osteomyelitis) + or if revascularization impossible<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La r\u00e8gle absolue avant toute compression d'un ulc\u00e8re de jambe est de mesurer l'IPS par Doppler. Appliquer une compression forte sur un ulc\u00e8re art\u00e9riel avec IPS <0,6 peut entra\u00eener une aggravation dramatique de l'isch\u00e9mie avec n\u00e9crose tissulaire \u00e9tendue et amputation. Cette erreur est \u00e9vitable par la simple mesure de l'IPS \u2014 un examen rapide, non invasif, r\u00e9alisable en consultation. En cas d'ulc\u00e8re mixte avec IPS entre 0,6 et 0,8, une compression l\u00e9g\u00e8re (20 mmHg) peut \u00eatre utilis\u00e9e sous surveillance m\u00e9dicale rapproch\u00e9e.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin ou un angiologue rapidement si un ulc\u00e8re de jambe ne cicatrise pas malgr\u00e9 les soins + ou si des signes d'isch\u00e9mie s\u00e9v\u00e8re apparaissent (douleur de repos + orteils froids et bleut\u00e9s + noircissement de la peau) + ou si une infection profonde de la plaie (cellulite + ost\u00e9omy\u00e9lite + fi\u00e8vre) est suspect\u00e9e. Consulter aux urgences imm\u00e9diatement si une gangr\u00e8ne humide + une septic\u00e9mie + ou une douleur de repos intense s'installent. Pour l'\u00e9valuation de l'IPS par Doppler et la prise en charge des plaies chroniques, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron \u00e9valuent les ulc\u00e8res de jambe et mesurent l'IPS par Doppler avant toute compression, distinguent les ulc\u00e8res veineux des ulc\u00e8res art\u00e9riels, initient la compression multicouches pour les ulc\u00e8res veineux (IPS \u2265 0,8), prescrivent les soins de plaie adapt\u00e9s selon la nature de l'ulc\u00e8re, orientent vers la chirurgie vasculaire pour revascularisation si IPS < 0,6, et coordonnent le suivi multidisciplinaire (infirmi\u00e8re en plaies + podiatre + vasculaire). Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin, d'un angiologue ou d'un chirurgien vasculaire. La compression veineuse est formellement contre-indiqu\u00e9e si l'IPS est inf\u00e9rieur \u00e0 0,6 \u2014 son application sur un ulc\u00e8re art\u00e9riel peut entra\u00eener une isch\u00e9mie aggrav\u00e9e et une amputation. Mesurer syst\u00e9matiquement l'IPS par Doppler avant toute compression.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Ulc\u00e8re de jambe veineux et art\u00e9riel : diagnostic diff\u00e9rentiel et traitement | Clinique Omicron M\u00e9decine vasculaire & Dermatologie & M\u00e9decine de famille Ulc\u00e8re de jambe veineux et art\u00e9riel Les ulc\u00e8res de jambe constituent une plaie chronique \u2014 d\u00e9finie par une perte de substance cutan\u00e9e ne cicatrisant pas spontan\u00e9ment en moins de 6 semaines malgr\u00e9 un… <a href=\"https:\/\/cliniqueomicron.ca\/en\/ulcere-veineux\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Venous and arterial leg ulcers: differential diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Ulc\u00e8re veineux \/ art\u00e9riel | Brossard | Clinique Omicron","_metasync_otto_description":"Ulc\u00e8re veineux \/ art\u00e9riel Ulc\u00e8re veineux \/ art\u00e9riel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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\n\t\t\t\t\t\n\n\n\n\nVenous and arterial leg ulcers: differential diagnosis and treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"L'ulc\u00e8re de jambe veineux r\u00e9sulte d'une insuffisance veineuse chronique et l'ulc\u00e8re art\u00e9riel d'une isch\u00e9mie. 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famille<\/span>\n <h1>Ulc\u00e8re de jambe veineux et art\u00e9riel<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Les ulc\u00e8res de jambe constituent une plaie chronique \u2014 d\u00e9finie par une perte de substance cutan\u00e9e ne cicatrisant pas spontan\u00e9ment en moins de 6 semaines malgr\u00e9 un traitement appropri\u00e9 \u2014 de la jambe ou du pied + repr\u00e9sentant un probl\u00e8me de sant\u00e9 fr\u00e9quent et invalidant qui touche 1 \u00e0 2 % de la population adulte dans les pays d\u00e9velopp\u00e9s + avec une pr\u00e9valence atteignant 3 \u00e0 5 % chez les personnes de plus de 65 ans. La cause la plus fr\u00e9quente est l'insuffisance veineuse chronique (ulc\u00e8re veineux \u2014 70\u201380 % des cas) + suivie de l'art\u00e9riopathie oblit\u00e9rante des membres inf\u00e9rieurs (ulc\u00e8re art\u00e9riel ou isch\u00e9mique \u2014 10\u201315 % des cas) + des ulc\u00e8res mixtes (art\u00e9rio-veineux \u2014 10\u201315 %) + et des causes moins fr\u00e9quentes (ulc\u00e8re diab\u00e9tique neuropathique + ulc\u00e8re de pression + vascularite + pyoderma gangrenosum + n\u00e9oplasique). La distinction entre ulc\u00e8re veineux et art\u00e9riel est fondamentale et urgente en pratique clinique \u2014 car leurs traitements sont radicalement oppos\u00e9s : la compression veineuse \u00e0 forte pression (bandage + bas de compression) est le pilier du traitement de l'ulc\u00e8re veineux + mais elle est absolument contre-indiqu\u00e9e dans l'ulc\u00e8re art\u00e9riel (la compression aggrave l'isch\u00e9mie et peut pr\u00e9cipiter une gangr\u00e8ne) \u2192 mesurer syst\u00e9matiquement l'index de pression systolique (IPS) avant toute compression. L'\u00e9valuation de l'IPS par Doppler de cheville est donc l'examen cl\u00e9 qui conditionne la prise en charge : IPS \u2265 0,8 = composante art\u00e9rielle absente ou mineure \u2192 compression possible + IPS < 0,6 = isch\u00e9mie s\u00e9v\u00e8re \u2192 compression contre-indiqu\u00e9e \u2192 revascularisation urgente.\n <\/div>\n\n <h2>Diagnostic diff\u00e9rentiel \u2014 caract\u00e9ristiques comparatives<\/h2>\n\n <table class=\"co-table\">\n <thead>\n <tr>\n <th>Characteristic<\/th>\n <th>Ulc\u00e8re veineux<\/th>\n <th>Arterial ulcer<\/th>\n <th>Ulc\u00e8re mixte<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Location<\/td>\n <td>R\u00e9gion mall\u00e9olaire interne (\u00abgu\u00eatre\u00bb) ++ + mall\u00e9ole interne et externe + tiers inf\u00e9rieur de la jambe<\/td>\n <td>Toes + heels + pressure areas + between toes + distal and acromial areas<\/td>\n <td>Variable \u2014 peut \u00eatre atypique<\/td>\n <\/tr>\n <tr>\n <td>Wound appearance<\/td>\n <td>Bords irr\u00e9guliers + fond rouge + ros\u00e9 + exsudatif + bordure hyperpigment\u00e9e (dermite ocre) + induration p\u00e9riulc\u00e9reuse<\/td>\n <td>Bords nets + \u00abperforant\u00bb + fond p\u00e2le ou noir\u00e2tre + n\u00e9crotique + peu ou pas d'exsudat + entour\u00e9 de peau fine + froide<\/td>\n <td>Mixed aspects<\/td>\n <\/tr>\n <tr>\n <td>Pain<\/td>\n <td>Mod\u00e9r\u00e9e + soulag\u00e9e par la sur\u00e9l\u00e9vation et la marche + aggrav\u00e9e en position d\u00e9clive (jambes pendantes)<\/td>\n <td>Intense + lancinante + aggrav\u00e9e par la sur\u00e9l\u00e9vation + soulag\u00e9e en position d\u00e9clive (jambes pendantes = position antalgique) + claudication<\/td>\n <td>Varies according to dominant component<\/td>\n <\/tr>\n <tr>\n <td>Pouls p\u00e9riph\u00e9riques<\/td>\n <td>Pr\u00e9sents (parfois masqu\u00e9s par l'\u0153d\u00e8me) + IPS normal \u2265 0,9<\/td>\n <td>Absents ou diminu\u00e9s + IPS < 0,8<\/td>\n <td>Diminu\u00e9s + IPS 0,5\u20130,8<\/td>\n <\/tr>\n <tr>\n <td>Peau p\u00e9ri-ulc\u00e9reuse<\/td>\n <td>Lipodermatoscl\u00e9rose + hyperpigmentation (dermite ocre = d\u00e9p\u00f4ts d'h\u00e9mosid\u00e9rine) + varices visibles + corona phlebectatica + ecz\u00e9ma veineux<\/td>\n <td>Peau froide + lisse + d\u00e9pil\u00e9e + blanche ou marbr\u00e9e + cyanose des orteils + ongles \u00e9pais<\/td>\n <td>Mixed<\/td>\n <\/tr>\n <tr>\n <td>Contributing factors<\/td>\n <td>Ant\u00e9c\u00e9dent de TVP + varices + ob\u00e9sit\u00e9 + s\u00e9dentarit\u00e9 + profession debout<\/td>\n <td>Tabagisme + HTA + diab\u00e8te + dyslipid\u00e9mie + ATCD coronarien ou AVC (ath\u00e9roscl\u00e9rose)<\/td>\n <td>Combining the two<\/td>\n <\/tr>\n <tr>\n <td>IPS (systolic pressure index)<\/td>\n <td>\u2265 0,9 (normal)<\/td>\n <td>< 0,6 (isch\u00e9mie s\u00e9v\u00e8re) ou 0,6\u20130,8 (isch\u00e9mie mod\u00e9r\u00e9e)<\/td>\n <td>0,5\u20130,8<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Index de pression systolique (IPS) \u2014 mesure indispensable<\/h2>\n <ul class=\"co-list\">\n <li><strong>Technology:<\/strong> ratio of systolic arterial pressure measured at the ankle (by Doppler) to systolic arterial pressure at the arm \u2192 IPS = Ankle BP \/ Arm BP<\/li>\n <li><strong>Interpr\u00e9tation :<\/strong> IPS \u2265 0,9 = normal + IPS 0,7\u20130,9 = isch\u00e9mie l\u00e9g\u00e8re + IPS 0,4\u20130,7 = isch\u00e9mie mod\u00e9r\u00e9e + IPS < 0,4 = isch\u00e9mie s\u00e9v\u00e8re (douleur de repos + risque d'amputation) + IPS > 1,3 = m\u00e9diacalcose (art\u00e8res incompressibles \u2014 diab\u00e8te + IRC + surestimation de la pression) \u2192 utiliser la pression digital ou le TcPO\u2082 dans ce cas<\/li>\n <li><strong>Compression thresholds :<\/strong> IPS \u2265 0,8 \u2192 compression \u00e0 forte pression autoris\u00e9e (40 mmHg) + IPS 0,6\u20130,8 \u2192 compression l\u00e9g\u00e8re possible (20\u201330 mmHg) sous supervision + IPS < 0,6 \u2192 compression CONTRE-INDIQU\u00c9E \u2192 r\u00e9f\u00e9rence vasculaire urgente<\/li>\n <\/ul>\n\n <h2>Traitement de l'ulc\u00e8re veineux<\/h2>\n <ul class=\"co-list\">\n <li><strong>Venous compression (mainstay of treatment) :<\/strong> multi-layer bandage (4 layers - Profore\u00ae + or equivalent) or short elasticity bandage - ankle pressure 35-45 mmHg + reduction in venous hypertension + improvement in venous return + healing rate at 12 weeks: 65-75 % under compression vs 20-25 % without compression + after healing: class II-III compression stockings for life to prevent recurrences<\/li>\n <li><strong>D\u00e9tersion et nettoyage de la plaie :<\/strong> mechanical debridement (curette + scalpel) + or enzymatic + or autolytic (hydrocolloid dressings) \u2192 remove necrotic tissue + biofilm + fibrin \u2192 promote budding<\/li>\n <li><strong>Dressings :<\/strong> choose according to the level of exudate + hydrocolloid dressings (moderate exudate) + silver dressings (if superinfection) + foams (abundant exudate) + interfaces (fragile wounds) + never occlude a superinfected wound \u2192 change 1-3 \u00d7 \/ week according to exudate<\/li>\n <li><strong>Venous surgery :<\/strong> treatment of underlying varicose veins (stripping + laser + sclerotherapy + EVLA) \u2192 reduces the risk of recurrence \u2192 to be considered after healing + or in parallel if varicose veins are severe<\/li>\n <li><strong>Greffe cutan\u00e9e :<\/strong> split-thickness skin graft + or keratinocyte graft + or skin substitutes \u2192 for large + chronic + non-healing ulcers despite optimal compression \u00d7 12 weeks<\/li>\n <li><strong>Pentoxifylline (Trental\u00ae) :<\/strong> 400 mg \u00d7 3\/d per os \u2192 improves microcirculation + reduces vascular inflammation + modest efficacy on healing in addition to compression<\/li>\n <\/ul>\n\n <h2>Traitement de l'ulc\u00e8re art\u00e9riel<\/h2>\n <ul class=\"co-list\">\n <li><strong>Revascularisation (traitement \u00e9tiologique) :<\/strong> percutaneous transluminal angioplasty (PTA) + or bypass surgery (prosthetic + or venous) + depending on location and extent of arterial lesions \u2192 objective: restore sufficient perfusion to allow healing<\/li>\n <li><strong>Traitement m\u00e9dical de l'ath\u00e9roscl\u00e9rose :<\/strong> statins + ACE inhibitors or ARB II + antiaggregants (aspirin + or clopidogrel) + strict blood pressure control + smoking cessation (essential) + diabetes control + progressive therapeutic walking (if GPI \u2265 0.5)<\/li>\n <li><strong>Soins locaux \u2014 plaie art\u00e9rielle :<\/strong> NON-occlusive dressings + dry maintenance of stable dry necrosis (protection) \u2192 do not debride dry necrosis without prior revascularization \u2192 moisten dressings + avoid maceration + delicate care<\/li>\n <li><strong>Compression CONTRE-INDIQU\u00c9E si IPS < 0,6 :<\/strong> worsens ischemia + risk of gangrene + amputation<\/li>\n <li><strong>Amputation:<\/strong> if irreversible ischemia + extensive dry or wet gangrene + osteoarticular infection (osteomyelitis) + or if revascularization impossible<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2119\ufe0f<\/span>\n <span>La r\u00e8gle absolue avant toute compression d'un ulc\u00e8re de jambe est de mesurer l'IPS par Doppler. Appliquer une compression forte sur un ulc\u00e8re art\u00e9riel avec IPS <0,6 peut entra\u00eener une aggravation dramatique de l'isch\u00e9mie avec n\u00e9crose tissulaire \u00e9tendue et amputation. Cette erreur est \u00e9vitable par la simple mesure de l'IPS \u2014 un examen rapide, non invasif, r\u00e9alisable en consultation. En cas d'ulc\u00e8re mixte avec IPS entre 0,6 et 0,8, une compression l\u00e9g\u00e8re (20 mmHg) peut \u00eatre utilis\u00e9e sous surveillance m\u00e9dicale rapproch\u00e9e.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Medical consultation recommended<\/div>\n <p>Consulter un m\u00e9decin ou un angiologue rapidement si un ulc\u00e8re de jambe ne cicatrise pas malgr\u00e9 les soins + ou si des signes d'isch\u00e9mie s\u00e9v\u00e8re apparaissent (douleur de repos + orteils froids et bleut\u00e9s + noircissement de la peau) + ou si une infection profonde de la plaie (cellulite + ost\u00e9omy\u00e9lite + fi\u00e8vre) est suspect\u00e9e. Consulter aux urgences imm\u00e9diatement si une gangr\u00e8ne humide + une septic\u00e9mie + ou une douleur de repos intense s'installent. Pour l'\u00e9valuation de l'IPS par Doppler et la prise en charge des plaies chroniques, Clinique Omicron offre des consultations m\u00e9dicales dans ses points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#c0392b;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins et infirmiers praticiens sp\u00e9cialis\u00e9s (IPS) de Clinique Omicron \u00e9valuent les ulc\u00e8res de jambe et mesurent l'IPS par Doppler avant toute compression, distinguent les ulc\u00e8res veineux des ulc\u00e8res art\u00e9riels, initient la compression multicouches pour les ulc\u00e8res veineux (IPS \u2265 0,8), prescrivent les soins de plaie adapt\u00e9s selon la nature de l'ulc\u00e8re, orientent vers la chirurgie vasculaire pour revascularisation si IPS < 0,6, et coordonnent le suivi multidisciplinaire (infirmi\u00e8re en plaies + podiatre + vasculaire). Des consultations sont disponibles dans plusieurs points de service au Qu\u00e9bec et en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, visitez <a href=\"https:\/\/cliniqueomicron.ca\" style=\"color:#4D6577;font-weight:600;text-decoration:none;\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">Le contenu de cette page est fourni \u00e0 titre informatif uniquement et ne remplace pas l'avis d'un m\u00e9decin, d'un angiologue ou d'un chirurgien vasculaire. La compression veineuse est formellement contre-indiqu\u00e9e si l'IPS est inf\u00e9rieur \u00e0 0,6 \u2014 son application sur un ulc\u00e8re art\u00e9riel peut entra\u00eener une isch\u00e9mie aggrav\u00e9e et une amputation. Mesurer syst\u00e9matiquement l'IPS par Doppler avant toute compression.<\/p>\n\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Ulc\u00e8re de jambe veineux et art\u00e9riel : diagnostic diff\u00e9rentiel et traitement | Clinique Omicron M\u00e9decine vasculaire & Dermatologie & M\u00e9decine de famille Ulc\u00e8re de jambe veineux et art\u00e9riel Les ulc\u00e8res de jambe constituent une plaie chronique \u2014 d\u00e9finie par une perte de substance cutan\u00e9e ne cicatrisant pas spontan\u00e9ment en moins de 6 semaines malgr\u00e9 un… <a href=\"https:\/\/cliniqueomicron.ca\/en\/ulcere-veineux\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Venous and arterial leg ulcers: differential diagnosis and treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Ulc\u00e8re veineux \/ art\u00e9riel | Brossard | Clinique Omicron","_metasync_otto_description":"Ulc\u00e8re veineux \/ art\u00e9riel Ulc\u00e8re veineux \/ art\u00e9riel est une condition m\u00e9dicale qui peut n\u00e9cessiter une \u00e9valuation et un suivi m\u00e9dical appropri\u00e9s. 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