Arterial Ulcers Flashcards
What is an ulcer?
Abnormal breaks in skin or mucous membranes (1% prevalence)
Lower limbs are majority what type of ulcer?
Venous (80%)
What causes a venous ulcer (commonly found on lower limb)
Venous insufficiency - valvular incompetence leads to impaired venous return - causing venous hypertension - “traps” WBC in capillaries and fibrin cuff forms around vessel - inflammatory mediators released causing tissue injury
What are the risk factors for venous ulcer development
- Increasing age
- Venous incompetence / venous thromboembolism history - including varicose veins
- Pregnancy
- Obesity/physical inactivity
- Severe leg injury/trauma
What are the clinical features of venous ulcers?
Painful in gaiter area of legs
Aching/itching/bursting sensation may present before venous ulcer appears
Ulcers typically shallow with granulating base and irregular borders
May find varicose veins/oedema on examination.
What investigations are done If suspected venous ulcer
Underlying venous insufficiency confirmed by ultrasound
Ankle Brachial Pressure Index determines if any arterial component to ulcers. If infection suspected - consider swabs and antibiotics
How are venous leg ulcers treated
Leg elevation and increased exercise + lifestyle changes
Mainly try to use compression bandaging (30-75% will heal after 6 months). ABPI must be over 0.6 for applying bandaging
How do arterial ulcers arise
Ulcers caused by decreased arterial blood flow = decreased perfusion of tissues
They form as small deep lesions with WELL defined borders and a necrotic base (remember venous ulcers have granulating base and irregular borders) - commonly form in sites of trauma and pressure areas
What are the RFs for arterial ulcers
PAD
Smoking, T2DM, hypertension, hyperlipidaemia, age, family history, obesity
What are common clinical features of arterial ulcers
Intermittent claudication (pain when they walk) or critical limb ischaemia (pain at night)
Ulcer may be painful - often develops over a long period of time with little to no healing
On examination, what signs may we find of arterial ulcer
Cold limbs and reduced/absent pulses.
Pure arterial ulcers maintain ulcers (unlike neuropathic ulcers).
What investigations must be done if suspected arterial ulcer?
Ankle Brachial pressure index (ABPI) - >0.9 normal
May also wanna do ultrasound, CT angio, magnetic resonance angiogram (MRA)
What are the management plans for arterial ulcers
Lifestyle changes
IF critical limb ischaemia - urgent referral for vascular review
May consider statins, anti platelet (aspirin/clopidogrel), BP optimisation
Surgical intervention includes angioplasty or bypass grafting
