Arterial Ulcer

Question 1

Define arterial ulcer

Answer 1

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.

Question 2

Explain the aetiology/risk factors of arterial ulcers

Answer 2

The ulcers are caused by a lack of blood flow to the capillary beds of the lower extremities

Question 3

Risk Factors

Answer 3

Coronary heart disease

History of stroke or TIA

Diabetes mellitus

Peripheral arterial disease (e.g. intermittent claudication)

Obesity and immobility

Question 4

Summarise the epidemiology of arterial ulcers

Answer 4

22% of leg ulcers

Prevalence increases with age and obesity

Question 5

Recognise the presenting symptoms of arterial ulcers

Answer 5

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

Question 6

NIGHT PAIN

Answer 6

• 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

Question 7

Recognise the signs of arterial ulcers on physical examination

Answer 7

Night pain  
Punched-out appearance  
Hairlessness  
Pale skin  
Absent pulses  
Nail dystrophy  
Wasting of calf muscles

Question 8

Identify appropriate investigations for arterial ulcers

Answer 8

Duplex ultrasonography of lower limbs - assess patency of arteries and potential for revascularisation or bypass surgery

ABPI

Percutaneous angiography

ECG

Fasting serum lipids, fasting blood glucose and HbA1c (diabetes is a major risk factor)

FBC - anaemia can worsen the ischaemia