Martorell's hypertensive ischemic leg ulcers are secondary to an increase in the local vascular resistance

In 1945 Martorell described ischemic leg ulcers in patients with hypertension and suggested that the ischemic necrosis was secondary to hypertensive arteriolar disease. The aim of the study was to examine the minimum vascular resistance in the skin of patients with these ulcers. Twelve control subjects (median age 52 years), eight patients with peripheral vascular disease (PVD) (median age 73 years), and six patients with hypertensive ulcers (median age 74 years) were studied. The minimum vascular resistance (MVR) and skin perfusion pressure (SPP) were determined by an isotope clearance method. Presence and severity of PVD were assessed by ankle/arm pressure ratios. The ulcer patients had a higher ankle/arm pressure ratio than the PVD group (p = 0.026) but had similar SPP (p = 0.47). When compared with the control group they had a similar pressure ratio (p = 0.09) but lower SPP (p = 0.001). The MVR was higher in the ulcer patients than the control subjects (p = 0.005) and the PVD group (p = 0.01). The study shows that patients with hypertensive ulcers have a high vascular resistance. This increase in resistance may interfere with the compensatory relaxation that normally occurs distal to an arterial narrowing, resulting in poor tissue perfusion and subsequent ulcer development.