Arterial Ulcers

Question 1

what are arterial ulcers caused by

Answer 1

ulcer caused by reduction in arterial blood flow, leading to decreased perfusion of the tissues and subsequent poor healing

Question 2

describe arterial ulcers

Answer 2

often form as small deep lesions with well-defined borders and a necrotic base

Question 3

where do they usually form

Answer 3

sites of trauma or pressure area such as the heel or big toe

Question 4

main risk factors

Answer 4

risk factors of peripheral arterial disease:

smoking, hyperlipidaemia, diabetes, overweight, age, family Hx, hypertension and inactivity

Question 5

clinical features

Answer 5

intermittent claudication (pain when they walk), critical limb ischaemia (pain at night), painful ulcer, progressive and insidious onset, little/no healing, cold limbs, thickened nails, necrotic toes,
limb will be cold and pulses will be reduced/absent
sensation is not lost

Question 6

what distinguishes arterial and neuropathic ulcers

Answer 6

sensation is not lost in pure arterial ulcers, it is lost in neuropathic ulcers though

Question 7

investigations

Answer 7

ABPI - ankle brachial pressure index,

duplex ultrasound, CT angiography/ MRA

Question 8

forumla for ABPI

Answer 8

ABPI = highest ankle systolic pressure/highest brachial systolic pressure

Question 9

how can you determine extent of peripheral arterial disease using ABPI

Answer 9

> 0.9 = normal; 0.9-0.8 = mild; 0.8-0.5 = moderate; <0.5 = severe

Question 10

NICE guideline on management of ulcers

Answer 10

NICE guidance states that any patient with critical limb ischaemia (i.e. those with ulcers) should be urgently referred for a vascular review.

Question 11

what 3 subsections of management are there in arterial ulcers

Answer 11

conservative, medical, surgical

Question 12

conservative management

Answer 12

advised lifestyle changes, including smoking cessation, weight loss, and increased exercise (specific supervised exercise programmes are available)

Question 13

medical management

Answer 13

Suitable pharmacological cardiovascular risk factor modification should also be prescribed, including statin therapy, an antiplatelet agent (aspirin or clopidogrel), and optimisation of blood pressure and glucose

Question 14

surgical management

Answer 14

Angioplasty (with or without stenting) or bypass grafting (usually for more extensive disease).
Any non-healing ulcers despite a good blood supply may also be offered skin reconstruction with grafts.