arterial ulcers

Question 1

Define an arterial ulcer?

Answer 1

localised area of damage and breakdown of skin due to inadequate arterial blood supply

usually seen on feet of patients with severe atheromatous narrowing of arteries supplying legs

Question 2

what is the cause of arterial ulcers?

Answer 2

ulcers caused by lack of blood flow to capillary beds of lower extremities

Question 3

what are the risk factors for arterial ulcers?

Answer 3

Coronary heart disease

History of stroke or TIA

Diabetes mellitus

Peripheral arterial disease (e.g. intermittent claudication, critical limb ischaemia)

Obesity and immobility

Question 4

summarise the epidemiology of arterial ulcers?

Answer 4

22% of leg ulcers

Prevalence increases with age and obesity

Question 5

what are the presenting symptoms of arterial ulcers?

Answer 5

distal- dorsum of foot or in between toes

punched out appearance

often eliptical with clearly defined edges

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 6

describe the night pain symptoms for arterial ulcers?

Answer 6

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 7

what are the signs of arterial ulcers on physical examination?

Answer 7

night pain

punched out appearance

hairlessness

pale skin

absent pulses

nail dystrophy

wasting of calf muscles

Question 8

what are the appropriate investigations for arterial ulcers?

Answer 8

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