Arterial Ulcer Flashcards
What is the definition of an atrerial ulcer?
A localised area of damage and breakdown of skin due to inadequate arterial blood supply. Usually seen on the feet of patients with severe atheromatous narrowing of the arteries supplying the legs.
What is the aetiology of an arterial ulcer?
The ulcers are caused by a lack of blood flow to the capillary beds of the lower extremities
What are the risk factors associated with arterial ulcers?
Coronary heart disease
History of stroke or TIA
Diabetes mellitus
Peripheral arterial disease (e.g. intermittent claudication)
Obesity and immobility
What is the epidemiology of arterial ulcers?
22% of leg ulcers
Prevalence increases with age and obesity
What are the presenting symptoms of arterial ulcers?
Often DISTAL - at the dorsum of the foot or between the toes
Punched-out appearance
Often elliptical with clearly defined edges
The ulcer base contains grey, granulation tissue
NIGHT PAIN - hallmark of arterial ulcers
- Pain is worse when supine (because arterial blood flow is further reduced when supine)
- Pain is relieved by dangling the affected leg off the end of the bed
What is the hallmark of arterial ulcers?
NIGHT PAIN - hallmark of arterial ulcers
- Pain is worse when supine (because arterial blood flow is further reduced when supine)
- Pain is relieved by dangling the affected leg off the end of the bed
What are the signs of arterial ulcers upon physical examination?
Night pain
Punched-out appearance
Hairlessness
Pale skin
Absent pulses
Nail dystrophy
Wasting of calf muscles
What are the appropriate investigations for arterial ulcers?
Duplex ultrasonography of lower limbs - assess patency of arteries and potential for revascularisation or bypass surgery
ABPI (ankle-branchial pressure index)
Percutaneous angiography
ECG
Fasting serum lipids, fasting blood glucose and HbA1c (diabetes is a major risk factor)
FBC - anaemia can worsen the ischaemia
