6] Arterial Wounds Flashcards
Aorta divides into?
R and L common iliac arteries
Common iliac divides into
Internal and external iliac arteries
Internal iliac artery supplies
Pelvis
External iliac artery becomes ? When it crosses ?
Femoral artery when it crosses inguinal ligament
Common femoral artery divides into
Superficial and deep femoral artery
What guides treatment for ulcers?
ABI
What’s the ABI scale??
NEED TO KNOW
0.9 to 1 = normal
0.75 to 0.9 = moderate disease
.5 to .75 = severe disease
Less than 0.5 = rest pain
Unreliable = diabetes
Deep femoral artery supplies muscles of
Thigh
Superficial femoral artery becomes
Popliteal artery
Superficial femoral artery is most common site of?
Atherosclerotic disease in LE
Popliteal artery goe smedial and divides below the knee to the 1st branch…
Anterior tib artery and tibioperoneal trunk
Tibioperoneal trunk divides into
Peroneal and posterior tibial arteries
Anterior tibial artery becomes
Dorsalis pedis artery
3 layers of the arterial wall
Adventitia
Media
Intima
Outer layer that has loose connective tissue
Adventitia
Middle layer that has elastic and muscular fibers that give strength, elasticity and contractibility
Media
Innermost layer- endothelial lining
Intima
Decreased circulation leading to ischemia and oxygen and nutrient deprivation
Arterial insufficiency
What happens in arterial insufficiency?
Cutaneous blood supply isnt enough and it leads to tissue death
You need enough arterial supply and venous return to?
Maintain oxygen and nutrition of the skin
Failure of artery supply or venous return can lead to ?
Wounds and healing wounds will be difficult
Will you do compression if they have arterial disease?
No
Characteristics of arterial ulcers?
6
- Even wound margins
- Pale, deep wound bed
- Extreme pain
- Minimal to no drainage
- Gangrene/necrosis
- Diminished or absent
pulses
Appearance of arterial ulcers
Distinct borders, pale or yellow base, surrounding skin is pale or red If in dependent position and thin and shiny
Not being quizzed on venous system but what should you know?
Theres a lot of veins goign back to the heart
Death of tissue in a part of body
Gangrene
Gangrene can be how big?
Small skin lesion or extend to entire limb
Gangrene initially appears how and then progresses how?
Initially pale then blue/grey then purple/black
Gangrene usually requires
Amputation
PVD is commonly associated with
Atherosclerotic disease
Tissue ischemia leads to
Necrosis
Most often, ulcers occur at?
Most distal sites
Color observation of limb
Pale
Mottled (smears of color)
Purplish
Black
Temperature observation of limb
Cool or cold may indicate arterial insufficiency
Skin changes- when observing limb
Loss of hair
Shiny
Thick hair
Risk factors of arterial ulcers
HTN High cholesterol Diet/obese Exercise DM Family history Age Smoking
When smoking, one cigarette decreases circulation
30% for one hour
Rest pain is ?
Severe
What’s considered moderate pain?
Pain after walking up a few stairs or less than 50 yards
What’s considered mild pain?
Pain after walking 1-2 blocks
Physical exam of arterial ulcers
System screen Observe limbs ANKLE BRACHIAL INDEX Pulses/Doppler Capillary refill Rubor of dependency
- Calciphylaxis
- Pyoderma gangrenosum Scleroderma
- Venous insufficiency
- Spider bites
- trauma
Conditions that might mimic arterial leg ulcers
Slow, progressive, incurable multisystem disorder
Scleroderma
Involves skin and internal organs;
inflammatory, vascular and sclerotic changes
Scleroderma
Are venous ulcers on the feet or the legs?
LEGS
Scleroderma has ?
Proliferation of fibroblasts, excessive collagen production
Patients with arterial ulcers you want to leave their legs ?
Dangling
Patients with venous ulcers should have their legs
Elevated ?
How does scleroderma skin appear
Shiny and hard with loss of mobility
What lesions on the trunk with scleroderma?
Morphea
How do you perform ABI?
Take BOTH brachial BPs in supine.
Put the cuff on the leg just above malleoli.
Put the Doppler at 45 degree angle to the dorsalis pedis or post tib artery.
Inflate cuff until Doppler is obliterated.
Slowly deflate the cuff until doppler signal comes back and record this as the ankle systolic pressure.
Divide ankle systolic by higher of the two brachial systolic pressures.
Behind the knee when knee is semiflexed
Popliteal artery
behind medial mallelolus. Supplies
posterior compartment of leg & plantar surface of foot
Posterior tib pulse
lateral to extensor hallicus longus.Supplies dorsal surface of the foot
Dorsalis pedis pulse
How would you describe pulses?
Weak
Bounding
Regular
Scale of pulses ?
0 = no pulse 1+ = barely felt 2+ = diminished 3+ = normal pulse 4+ = bounding
Venous filling time
Pt in supine with foot elevated to 45-60 deg for 1 min, bring foot into dependent position and look at skin color changes
Less than 15 sec for venous filling time is
Normal
If venous filling time = 15 - 40 seconds
Moderate arterial insufficiency
More than 40 seconds for venous filling time
Severe ischemia
Rubor of dependency
Pt in supine and elevate their leg 60 degrees for 1 minute.
Normal is when the pink decreases when returning back down.
+ would be pale appearance that turns to cherry red when lowered to dependent position.
Intervention for arterial ulcers
Local wound care Education about smoking Limb protection Refer to vascular surgeon Exercise of walking program
Do you debride gangrene?
NO
3 types of wound prognosis
Healable
Maintenance
Nonhealable (palliative)
maintain moisture and bacteria balance
Healable wound
(wound that could heal but ptfactors such as uncontrolled DM or smoking make healing less likely)
Maintenance wound
Two surgical interventions for arterial ulcers
Percutneous balloon angioplasty and femoropoploteal bypass graft
Percutaneous balloon angioplasty is used for
Short term segment stenosis
Femoropopliteal bypass graft is
The standard treatment
