Lecture 4a - Vascular Ulcers Flashcards
What % of all LE ulcers are arterial ulcers?
5-10%
What does an arterial ulcer look like?
- round
- regular shaped
- punched-out appearance
- pale wound bed
- may have necrotic tissue
- may present as dry gangrene-dry, dark, cold, and contracted area
Where are arterial ulcers normally found?
distal LE
commonly on toes, lateral malleolus, or anterior leg
Is there bleeding in arterial ulcers?
minimal bleeding/drainage
Are arterial ulcers painful?
Usually painful (cramping, aching, or fatigue) but can be masked by neuropathy
- pain increased by activity and elevation of wound are
what type of ulcer is this?
Arterial Ulcer
Describe the arterial ulcer periwound.
- lack of hair
- skin is shiny, thin, dry
- increased fungal growth
- nails are yellow/thickened
- limb is pale/cyanotic or shows dependent rubor
- cold to touch
- usually no edema
- lack palpable pulses
Risk factors for arterial ulcers
- Arterial insufficiency
- Hyperlipidemia/elevated cholesterol
- Smoking
- DM
- HTN
- Trauma
- Advanced Age
What are some causes for Arterial Insufficiency (AI)?
- Trauma
- Acute embolism
- Thromboangiitis
- Buerger’s disease
- Microvascular disease
- Arteriosclerosis/atherosclerosis
What is the primary cause of AI?
Arteriosclerosis: thickening/hardening of arterial walls
What’s the most common form of arteriosclerosis?
Systemic, degenerative process in which arterial lumen is gradually/progressively approached upon
- circulating cholesterol attaches plaque to vessel walls
How does smoking lead to an increased risk for arterial ulcers?
- Nicotine causes vasoconstriction
- Decrease available O2
- Increase clot formation rate & blood viscosity
- Nicotine enhances cholesterol deposition in vessels
- O2 delivery/demand mismatch
What is the #1 modifiable risk factor for PVD?
Smoking
80% of patients with PAD are current or former smokers
Why is Diabetes a risk for arterial ulcers?
- increased calcification
- hyperglycemia impairs all phases of healing
- increased neuropathy prevalence that can mask pain
Which HTN is worse for arterial ulcers?
Systolic HTN is worse than diastolic HTN
- increased force initiates / perpetuates endothelial cell injury
Although ulcers can occur spontaneously, most are caused by _____
trauma
including chemical & thermal traumas
Why is age a risk factor for arterial ulcers?
Difficulty adapting to metabolic demands; plaques build up over time
What does ischemic rest pain look like?
More significant arterial disease, burning pain occurs at night or with elevation and RELIEVED with dependency
If you hear “cramping, burning, fatigue,” you think _____ ulcer
Arterial Ulcer
If you hear that the ulcer is distal to the site of occlusion, repeatable or predictable, we’re thinking ______ ulcer
Arterial Ulcer
Some ways to test for an arterial ulcer include?
- Pulses
- Doppler Ultrasound
- Capillary refill
- Rubor
- Venous filling time
- ABI
- TBI
- Transcutaneous O2 monitoring
- CTA
- MRA
What is a doppler ultrasound?
Handheld probe that makes an audible signal when placed over moving fluid
Which pulses should you check for with arterial ulcers?
- femoral
- popliteal
- dorsalis pedis
- posterior tibial
Which testing is more sensitive to pulses: Palpation or Doppler Ultrasound?
Doppler Ultrasound
Slide says: The absence of palable pulses should be followed up with more sensitive testing such as Doppler Ultrasound.