Martorell Hypertensive Ischemic Leg Ulcer

Hafner, Jürg; Nobbe, Stephan; Partsch, Hugo; Läuchli, Severin; Mayer, Dieter; Amann-Vesti, Beatrice; Speich, R; Schmid, Christoph; Burg, Günter; French, Lars E.

doi:10.1001/archdermatol.2010.224

Cited by 110 publications

(66 citation statements)

References 30 publications

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“…From May 1999 to April 2011, 46 patients with Martorell ulcer were diagnosed at the Department of Dermatology, University Hospital of Zurich [4]. After reviewing the cases, a total of 15 patients were identified for further diagnostic workup according to the study design (Figure 2).…”

Section: Methodsmentioning

confidence: 99%

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Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Blotzheim¹,

Tanner²,

Noll³

et al. 2012

Respiratory Research

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BackgroundMartorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders.MethodsIn this case–control study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls.ResultsSystolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8 ± 16.9 vs 25.3 ± 6.5 mmHg, p = 0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p = 0.031). No differences were seen in left heart size and function between patients and controls.ConclusionThis study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension.

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Section: Methodsmentioning

confidence: 99%

“…Histology reveals hypertrophy of the smooth muscle cell layer of the vessel’s media resulting in an increased thickness of the arteriolar wall to the cost of a narrow lumen (Figure 1a/b). Systemic arterial hypertension is present in all cases, type 2 diabetes is observed in approximately 60% [4-6]. …”

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Blotzheim¹,

Tanner²,

Noll³

et al. 2012

Respiratory Research

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“…Die Diagnose kann gestellt werden bei rasch progredierenden und extrem schmerzhaften Hautnekrosen am laterodorsalen Unterschenkel oder über der Achillessehne [1]. Relevant wird die Diagnose insbesondere deshalb, weil das Ulcus hypertonicum Martorell offenbar nicht selten mit einem Pyoderma gangraenosum verwechselt wird.…”

Section: Transfer In Die Praxis Von Prof Dr Markus Stücker (Bochum)unclassified

“…Die Therapie des Ulcus hypertonicum Martorell besteht in der chirurgischen Exzision der Nekrosen, wodurch es häufig zu einer raschen Schmerzlinderung kommt [1]. Damit verbunden ist häufig eine invasive interventionelle oder gefäßrekonstruktive Therapie einer Arteriosklerose der Beingefäße erforderlich.…”

Section: Transfer In Die Praxis Von Prof Dr Markus Stücker (Bochum)unclassified

Obliterierende subkutane Arteriolosklerose nicht spezifisch für ein Ulcus hypertonicum Martorell

Stücker

2019

Kompass Dermatol

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Background: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of ‘arteriolosclerosis.' The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. Methods: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. Results: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p < 0.0001). Conclusion: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

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“…The pathogenesis is associated with local factors triggering dermal arteriosclerosis and subsequent hyperplasia of the media layer and elastic lamina, a process known as hyalinosis [2]. This results in ischaemic changes leading to skin necrosis – hence ulceration [3, 4, 5]. The ulcer first appears as a solitary painful blister on the outer aspect of the lower leg [2] and eventually takes on an irregular deep appearance, which may lead to exposure of the underlying structures such as tendons.…”

Section: Introductionmentioning

confidence: 99%

Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer

et al. 2017

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Martorell ulcer is a form of lower limb ulceration, preceded by a small area of excruciating pain. It often appears as a solitary lesion on the outer aspect of the lower limb, and is primarily associated with poorly controlled hypertension and diabetes. Treatment of the ulcer involves awareness and early correct diagnosis, adequate control of blood pressure, management of infection, and wound care. We describe a 77-year-old diabetic and hypertensive woman presenting with excruciating pain in her right lower lateral leg leading to a necrotic ulcer. Serial photographs of the evolution of the lesion and eventual healing of the ulcer are presented.

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Martorell Hypertensive Ischemic Leg Ulcer

Abstract: To better define the diagnosis and treatment of Martorell hypertensive ischemic leg ulcer (HYTILU) and to compare Martorell HYTILU with calciphylaxis (calcific uremic arteriolopathy) and nonuremic forms of calciphylaxis.

Cited by 110 publications

References 30 publications

Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Obliterierende subkutane Arteriolosklerose nicht spezifisch für ein Ulcus hypertonicum Martorell

Painful Leg Ulceration in a Poorly Controlled Hypertensive Patient: A Case Report of Martorell Ulcer

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