Arterial Ulcers Flashcards
Etiology of arterial ulcers
Arterial insufficiency/vessel stenosis or occlusion
Cutaneous blood supply inadequate to meet metabolic demands, resulting in tissue death
Borderline bloodflow may be asymptomatic until a minor trauma increases demand
Primary cause is arteriosclerosis-thickening/hardening of arterial walls-most common is atherosclerosis
Angiopathy in ALU
Poor perfusion of nutrients and o2 for wound healing
macroangiopathy-large vessels, affects B LE
microangiopathy-small vessel disease with possible sclerosis
Ischemic/arterial Ulcer risk factor
arteriosclerosis diabetes hyperlipidemia thrombosis smoking males over 50
ALU presentations
poor pulse DISTAL THIRD OF LE pretibial or dorsal foot cool to touch rubor of dependence punched out appearance with smooth edges pale, dry wound bed with likely necrosis may have eschar may have loss of hair trophic changes present painful associated with intermittent claudication, pain with elevation or ischemic rest pain
Test for ALU
capillary refill palpable pulses doppler rubor of dependency venous filling time ABI Toe pressures segmental pressures TcPO2 arteriogram
Rubor of dependency
redness due to pt keeping leg declined to get blood via gravity
supine, elevate leg to 60* for 1 minute
assess color of plantar foot: if a dark red color , can indicate dependency
capillary refill
surface arterial blood flow
observe toe color
hold distal toe for 5 seconds (enough to blanche)
record time to return to normal (3s)
Pulse Exam
0=no pulse 1+=barely felt 2+=diminished 3+=normal 4+= bounding
Arterial Doppler
dorsalis pedis or posterior tib hold doppler at 45* describe sound monophasic=severe arterial involvement biphasic=some arterial involvement triphasic=normal
Venous Filling Time
pt supine, elevate feet to 45-60*, hold until blanched, bring feet into dependent position
note time veins re-distend on dorsal foot.
normal is <15s
15-40s moderate arterial insufficiency
ABI
Not always reliable in diabetics
pt supine with pillow, place cuff around ankle, find post tib pulse, inflate cuff till pulse disappears. deflate cuff and record first audible pulse.
Repeat using brachial artery (on both UE)
ABI Values
> 1 is normal or venous
.8-1 some arterial involvement
<.5 urgent vascular referral
Toe pressures
diabetic pts have arteries that are sclerosed open
ABI results inaccurate due to non-compressability of the arteries
Toe pressures more reliable
Segmental pressures
performed in vascular lab
non-invasive
done at various proximal and distal points
Transcutaneous O2 measurements
leads placed on skin
control lead near heart
measures hypoxis-how much o2 at level of extremity
used to know where to amputate or if hyperbaric 02 would be useful
