Arterial ulcers

Question 1

Define arterial ulcer

Answer 1

Localised area of damage & breakdown of skin due to inadequate arterial blood supply

Usually seen on the feet of patients w/ severe atheromatous narrowing of the arteries supplying the legs

Question 2

Aetiology of arterial ulcer

Answer 2

Ulcers caused by lack of blood flow to the capillary beds of the lower extremities

Question 3

Epidemiology of arterial ulcers

prevalence, risk factors

Answer 3

• 22% of leg ulcers

- Prevalence inc. w/ age & obesity

Question 4

Presenting symptoms of arterial ulcers

5

Answer 4

• Often distal (dorsum of foot or between toes)
• Punched out appearance
• Often elliptical w/ clearly defined edges
• Ulcer base contains grey granulation tissue

NIGHT PAIN - hallmark

• Pain worse when supine (arterial blood flow further reduced)
• Pain relieved by dangling affected leg off the end of the bed

Question 5

Signs of arterial ulcers on physical examination

7

Answer 5

• Night pain
• Punched out appearance
• Hairlessness
• Pale skin
• Absent pulses
• Nail dystrophy
• Wasting of calf muscles

Question 6

Appropriate investigations for arterial ulcers

6

Answer 6

Duplex ultrasonography of lower limbs
- Assess patency of arteries & potential for revascularisation or bypass surgery

ABPI

Percutaneous angiography

ECG

Fasting serum lipids, fasting blood glucose & HbA1c
- Diabetes is major risk factor

FBC
- Anaemia can worsen ischaemia

Question 7

Risk factors for arterial ulcer

5

Answer 7

Coronary heart disease
History of stroke or TIA
Diabetes mellitus
Peripheral arterial disease 
Obesity & immobility