Atererial ulcer

Question 1

Arterial ulcer?

Answer 1

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

Arterial ulcer aetiology?

Answer 2

caused by a lack of blood flow to the capillary beds in the lower extremities.

Question 3

Arterial ulcer risk factors (6)?

Answer 3

Coronary heart disease, history of stroke or TIA, DM, peripheral arterial disease, obesity, immobility.

Question 4

Arterial ulcer epidemiology?

Answer 4

22% of leg ulcers

Question 5

Arterial ulcer symptoms (6)?

Answer 5

often distal, at dorsum of foot or between toes,

pouched out appearance,

elliptical with clearly defined edges,

base contains grey, granulation tissue.

Night pain is the hallmark, worse when supine, relieved by dangling leg off bed

Question 6

Arterial ulcer signs (6)?

Answer 6

Pouched out, hairless, pale skin, absent pulses, nail dystrophy, wasting of calf muscles.

Question 7

Arterial ulcer investigations?

Answer 7

Duplex ultrasonography of lower limbs (to assess patency of arteries and for potential revascularisation or bypass surgery) ABPI, percutaneous angiography, ECG.