Arterial Ulcers

Question 1

What is an arterial ulcer?

Answer 1

Localised damage + breakdown of skin due to inadequate arterial blood supply.
Usually seen on feet of patients with severe atheromatous narrowing of arteries supplying the legs.

Question 2

Describe the aetiology of arterial ulcers

Answer 2

Caused by lack of blood flow to the capillary beds of the lower extremities

Question 3

List 5 risk factors for arterial ulcers

Answer 3

Coronary heart disease 
Hx of stroke or TIA  
Diabetes mellitus  
Peripheral arterial disease (e.g. intermittent claudication, critical limb ischaemia) 
Obesity + immobility

Question 4

Describe the epidemiology of arterial ulcers

Answer 4

22% of leg ulcers

Prevalence increases with age + obesity

Question 5

Describe the distribution/ appearance 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
Ulcer base contains grey, granulation tissue

Question 6

List 3 symptoms of arterial ulcers

Answer 6

NIGHT PAIN: hallmark of arterial ulcers
Pain WORSE when supine (because arterial blood flow is further reduced when supine)
Pain RELIEVED by dangling affected leg off end of the bed

Question 7

List 6 signs of arterial ulcers

Answer 7

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

Question 8

Name 2 important investigations for arterial ulcers

Answer 8

ABPI <0.9

Duplex ultrasonography of lower limbs: assess patency of arteries + potential for revascularisation or bypass surgery

Question 9

List 4 other investigations that may be performed post arterial ulcer diagnosis

Answer 9

Percutaneous angiography
ECG
Fasting serum lipids, fasting blood glucose + HbA1c (DM is a major RF)
FBC: anaemia can worsen the ischaemia