Arterial Ulcers

Question 1

Define arterial ulcer

Answer 1

A localised area of damage and breakdown of skin due to inadequate arterial blood supply - usually seen on the feet of patients with severe atheromatous narrowing of the arteries supplying the legs

Question 2

What are the causes/risk factors of arterial ulcers?

Answer 2

• Coronary heart disease
• History of stroke or TIA
• Diabetes mellitus
• Peripheral arterial disease (e.g. intermittent claudication)
• Obesity and immobility

Question 3

What are the signs and symptoms of arterial ulcers?

Answer 3

• Often DISTAL - at the dorsum of the foot or between the toes
• Punched-out appearance
• Often elliptical with clearly defined edges
• The ulcer base contains grey, granulation tissue
• NIGHT PAIN - hallmark of arterial ulcers
- Pain is worse when supine (because arterial blood flow is further reduced when supine)
- Pain is relieved by dangling the affected leg off the end of the bed
• Hairlessness
• Pale skin
• Absent pulses
• Nail dystrophy
• Wasting of calf muscles

Question 4

What investigations are carried out for arterial ulcers?

Answer 4

• Duplex ultrasonography of lower limbs - assess patency of arteries and potential for revascularisation or bypass surgery
• ABPI
• Percutaneous angiography
• ECG
• Fasting serum lipids, fasting blood glucose and HbA1c (diabetes is a major risk factor)
• FBC - anaemia can worsen the ischaemia