Arterial and venous ulcers

Question 1

An ulcer is defined as chronic sore on the leg that takes more than 2 weeks to heal. Are arterial of venous ulcers more common?

Answer 1

• venous
• accounts for 80% of ulcers

Question 2

What is the main cause of an arterial ulcer?

1 - AF
2 - HF
3 - PVD
4 - COPD

Answer 2

3 - PVD

Question 3

Arterial ulcers have all of the following features EXCEPT which one?

1 - Spontaneous (no trauma)
2 - Punched out and deep
3 - Tight, dry skin
4 - Hairless legs
5 - Necrotic but dry ulcer
6 - Normal/high ABPI

Answer 3

6 - Normal/high ABPI
- typically low

Question 4

Which of the following locations do arterial ulcers NOT typically form?

1 - dorsum of foot
2 - lateral malleolus
3 - toes
4 - gaiter area of leg

Answer 4

4 - gaiter area of leg

Question 5

In arterial ulcers is the pain severe or mild?

Answer 5

• severe
• associated claudication is common

Question 6

Which 2 of the following are typically used to treat arterial ulcers?

1 - angioplasty
2 - bypass
3 - compressions
4 - all of the above

Answer 6

1 - angioplasty
2 - bypass

• same approach as critical limb ischaemia where revascularisation is important or amputation

Question 7

What is the main cause of an venous ulcers?

1 - AF
2 - HF
3 - PVD
4 - venous hypertension

Answer 7

4 - venous hypertension

Question 8

Venous ulcers have all of the following features EXCEPT which one?

1 - Traumatic event (75% e.g. bites, burns, infections etc)
2 - Irregular shape, sloped edges,
Oedematous skin and shallow
3 - No exudate
4 - Lipodermatosclerosis and haemosiderin deposits
5 - Normal/high ABPI

Answer 8

3 - no exudate
- they have significant exudate

Question 9

In venous ulcers is the pain severe or mild?

Answer 9

• mild
• no claudication

Question 10

Which of the following locations do venous ulcers typically form?

1 - dorsum of foot
2 - lateral malleolus
3 - toes
4 - gaiter area of leg

Answer 10

4 - gaiter area of leg

Question 11

Which of the following are typically used to treat venous ulcers?

1 - angioplasty
2 - bypass
3 - compressions
4 - all of the above

Answer 11

3 - compressions
- also need to treat varicosities

Question 12

If a patient has a mixed venous and arterial ulcer, which is most important to fix?

Answer 12

• arterial
• then can focus on venous

Question 13

Should compression be avoided in arterial and venous ulcers?

Answer 13

• avoided in arterial but not venous
• Graduated compression bandaging exerting around 35 – 40 mmHg at the ankle is the mainstay of treatment of active venous ulceration
• diminishes leg vein distension and stasis by cutting down on inflammation
• diminishes oedema and improves tissue perfusion and transfer
• improves overall venous function by improving venous pump function
• keeps skin dry and avoids maceration of skin

Question 14

Management of venous ulcers is as follows: