Arterial ulcers

Question 1

What usually causes arterial ulcers?

Answer 1

• Chronic ischaemia
• Large vessel disease (e.g. atherosclerosis)
• Small vessel disease (e.g. diabetes)

Question 2

Where do arterial ulcers usually occur?

Answer 2

On pressure areas or toes

Question 3

What are the main symptoms of arterial ulcers (in comparison to venous ulcers)?

Answer 3

Pain at rest

Question 4

What are the clinical signs of an arterial ulcer?

Answer 4

• Punched out edge
• Sloughy base
• May be deep
• Poor peripheral pulses
• Other signs of limb ischaemia (6 Ps)

Question 5

How are arterial ulcer diagnosed and managed?

Answer 5

Management same as for ischaemic limb

• Skin may need debridement and graft following revascularisation
• Amputation for uncontrolled pain

Question 6

What associated trophic features may be seen in the leg?

Answer 6

Pale skin
Hair loss
Onchogryphosis
Fungal infections