Arterial and venous ulcers

Question 1

Where do venous ulcers typically occur

Answer 1

Gaiter area of leg - ankle to mid-calf above medial malleolus

Question 2

Arterial ulcer features

Answer 2

Smaller and deeper than venous
Well defined borders
Punched out appearance
Occur peripherally
Have reduced bleeding
Are painful

Question 3

Venous ulcer features

Answer 3

Post minor injury
Larger and more superficial than arterial
Irregular gently sloping borders
Affect gaiter area of leg - mid calf down ankle
Less painful than arterial ulcers
Occur w other signs of chronic venous insufficiency

Question 4

What are arterial ulcers caused by

Answer 4

Ischaemia secondary to iadequate bloodsupply

Question 5

What are venous ulcers caused by

Answer 5

Impaired drainage and pooling of blood in legs

Question 6

ABPI results and interpretation

Answer 6

0.9 – 1.3 is normal
0.6 – 0.9 indicates mild peripheral arterial disease
0.3 – 0.6 indicates moderate to severe peripheral arterial disease
Less than 0.3 indicates severe disease to critical ischaemic
An ABPI above 1.3 can indicate calcification of the arteries, making them difficult to compress.

Question 7

Features of skin around venous ulcer

Answer 7

Chronic venous insufficiency
Oedema, pigmenetation, lipodermatosclerosis - hardened and discolouration of skin, atrophie blanche - small white scars surrounded by dilated capillaries

Question 8

What investigation may happen if ulcer not responding to treatment

Answer 8

Biopsy

Question 9

Mainstay of venous ulcer treatment

Answer 9

Compression therapy
Wound care - involving regular cleanding and dressing of ulcer
Topical agents to control bacterial overgrowth and promote wound healing, some may need debridement
Systemic analgesics antibiotics for cellulitis

Question 10

Recurrent or non healing ulcer treatment

Answer 10

Endovenous ablation
Sclerotherapy
Venous valave repair