Arterial Ulcers

Question 1

Define Arterial Ulcers

Answer 1

Ischaemic ulcer that is formed from an ischaemic wound, commonly located on the lateral surface of the ankle or distal digits

Question 2

Aetiology of Arterial Ulcers

Answer 2

Peripheral artery disease from atherosclerosis -> lack of blood flow to capillary beds of lower extremities

Pressure on skin -> damage -> repair hindered by poor tissue perfusion -> microangiopathy, neuropathy and capillary autoregulation

Question 3

Risk factors of Arterial Ulcers

Answer 3

Smoking
DM 
Hyperlipidaemia 
>40 
Cardiovascular disease
HTN 
Vasculitis

Question 4

Presenting symptoms of Arterial Ulcers

Answer 4

Painful ulcer (“punched-out”, covered with slough and necrotic/gangrenous tissue, minimal exudate, grey/yellow fibrotic base, undermining skin margins)
Often worse on the distal ends of the limbs (between toes, lateral foot, ankle)
Pain worse at night and on leg elevation / relieved by hanging leg out the bed or sleeping in chair

Question 5

Signs of Arterial Ulcers on examination

Answer 5

Painful ulcer (punched out, covered with slough/necrotic/gangrenous material, minimal exudate, grey/yellow fibrotic base) 
Weak or absent peripheral pulses
Cold skin 
Thin, shiny skin 
Absence of hair

Question 6

Investigations for Arterial Ulcers

Answer 6

Ankle Brachial index ABI: <0.9 = PAD

Toe-brachial index < 0.4
Duplex USS - shows peak systolic velocity ratio >2
Continuous wave doppler USS: pulsatility index decrease between adjacent proximal and distal anatomical segments
Catheter angiography/CT angiogram/MR angiography: anatomica detail of stenoses or occlusion
CK: check for muscle damage + monitoring