Managing peripheral arterial disease and vascular ulcers.

Peripheral vascular disease is common and often undiagnosed. Painful vascular ulcers and intermittent claudication greatly reduce mobility and quality of life. Screening for diagnosis is best accomplished by an ankle brachial index, whereas anatomic visualization of the arterial anatomy may be necessary to plan treatment. Vascular disease produces ulcers with a gangrenous appearance, which are resistant to topical treatments. Medical therapy has had limited success. Surgical correction of vascular insufficiency by bypass, angioplasty, or stenting improves outcomes when feasible. Supervised exercise rehabilitation is superior to both medical therapy and surgical therapy.