Arterial Ulcers Flashcards
Define Arterial Ulcer?
A localised area of damage and breakdown of skin due to inadequate arterial blood supply
Where are Arterial Ulcers usually seen?
On the feet of patients with severe atheromatous narrowing of the arteries supplying the legs
What is the aetiology of Arterial Ulcers?
Caused by a lack of blood flow to the capillary beds of the lower extremities
What are the risk factors for Arterial Ulcers?
Coronary Heart Disease History of stroke or TIA Diabetes Mellitus Peripheral Arterial Disease (e.g. Intermittent claudication) Obesity and immobility
What is the epidemiology of Arterial Ulcers?
22% of leg ulcers
Prevalence increases with age and obesity
What is the hall mark of Arterial Ulcers?
Night Pain
What are the characteristics of Night Pain?
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
What are the presenting symptoms of Arterial Ulcers?
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
What are the signs of Arterial Ulcers on physical examination?
Night pain Punched-out apperance Hairlessness Pale Skin Absent pulses Nail dystrophy Wasting of calf muscles
What investigations would we do for Arterial Ulcers?
Duplex Ultrasonography of lower limbs ABPI Percutaneous angiography ECG Fasting serum lipids, blood glucose and HbA1c FBC
What does Duplex Ultrasonography of lower limbs do in Arterial Ulcers?
Assess patency of arteries and potential for revascularisation or bypass surgery
Why do we do a HbA1c test for Arterial Ulcers?
Diabetes is a major risk factor
Why do we do a FBC for Arterial Ulcers?
Anaemia can worsen the ischaemia
