Arterial Ulcers

Question 1

Define

Answer 1

DEFINITION: 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

Causes

Answer 2

The ulcers are caused by a lack of blood flow to the capillary beds of the lower extremities

Risk Factors

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

Question 3

Epidemiology

Answer 3

22% of leg ulcers

Prevalence increases with age and obesity

Question 4

Symptoms

Answer 4

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

Question 5

Signs

Answer 5

Night pain

Punched-out appearance

Hairlessness

Pale skin

Absent pulses

Nail dystrophy

Wasting of calf muscles

Question 6

Investigations

Answer 6

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