Peripheral Vascular Disease

Question 1

RFs for venous ulcers?

Answer 1

Varicose veins
Prev DVT
Phlebitis
Prev fracture, trauma or surgery 
FH
Venous insufficiency 
Obesity

Question 2

What is the major background RF for venous leg ulcers?

Answer 2

Venous insufficiency - leg pain, heavy legs, oedema, ache/itch, skin breakdown or pigmentation, eczema

Question 3

Symptoms of venous insufficiency?

Answer 3

Leg pain
Heavy legs, oedema
Itching
Skin breakdown/eczema, pigmentation change

Question 4

RFs for arterial leg ulcers?

Answer 4

Hx of arterial disease - CVD, CVA, HTN, PAD (intermittent claudication)
DM
Smoking
Obesity, immobility

Question 5

Describe what venous ulcers look like?

Answer 5

Often the circumference of the lower leg, mid-calf down to medial malleoli
Large but shallow, moist pink granulation base with irregular border
May ooze a bit
Surrounding signs - oedema, varicose veins, stasis dermatitis, hyperpigmentation, lipodermatosclerosis

Question 6

What pain may be experienced in association with venous ulcers?

Answer 6

Venous insufficiency pain - eased by elevation

Question 7

Where are venous ulcers typically found?

Answer 7

Circumference of lower leg, often distribution of medial saphenous venous system (mid calf down to malleoli)

Question 8

What ulcer is typically shallow and has a moist, pink granulation base with irregular borders?

Answer 8

Venous

Question 9

If handling causes oozing, what type of ulcer does that suggest?

Answer 9

Venous

Question 10

What do arterial ulcers look like?

Answer 10

Often deeper and more distal than venous, on the dorsum of foot/toes
May be quite well defined
Grey granulation tissue at base
Surrounding signs - chronic ischaemia (pale, pulseless, cold, hairless, nail dystrophy and calf muscle wastage)

Question 11

What pain may be associated with arterial ulcers?

Answer 11

Intermittent claudication

Or nocturnal pain which is eased by dangling leg over bed

Question 12

Signs of chronic limb ischaemia?

Answer 12

Pale
Pulseless (diminished)
Cold
Painful
Paraesthesia
Paralysis/muscle wastage 
Hair loss/nail dystrophy

Question 13

What ulcer is indicated by a well-defined, deep grey lesion on the dorsum of the foot?

Answer 13

Arterial

Question 14

What is the typical appearance associated with neuropathic ulcers?

Answer 14

Punched out - deep

Under pressure points and surrounded by chronic inflammatory tissue

Question 15

What ulcers are prone to painless, heavy bleeding on palpation?

Answer 15

Neuropathic

Question 16

Possible presentations of diabetic ulcers?

Answer 16

Often a mixed picture as neuropathic, arterial and even venous components may contribute
However often over a bony prominence (in a known DM patient!)

Question 17

How do hypertensive ulcers typically present?

Answer 17

Lateral aspect of leg, painful with necrotic edges

Question 18

What is a normal ABPI?

Answer 18

Around 1

Question 19

What does a raised ABPI generally suggest?

Answer 19

If there are ulcers present they are likely to be venous

May be due to calcification of arteries - atherosclerosis, DM

Question 20

What type of ulcers are more likely to be present with a raised ABPI?

Answer 20

Venous

Question 21

What does an ABPI of

Answer 21

Probably arterial disease - ulcers are likely to be arterial unless obviously clinically venous

Question 22

What must be absolutely avoided in an ABPI of

Answer 22

Compression stockings

Question 23

2 conditions that can give a ‘falsely raised’ ABPI?

Answer 23

Atherosclerosis

DM

Question 24

Systemic vascular disease types of ulcers?

Answer 24

Rheumatoid ulcers

Systemic vasculitis associated (wegeners, SLE, scleroderma)

Question 25

What must be excluded before giving compression devices for venous insufficiency symptoms?

Answer 25

DM, arterial disease (ABPI) and neuropathy

Question 26

What medication can be used for chronic venous ulcers?

Answer 26

Pentoxyfilline

Question 27

What are the most common type of leg ulcer?

Answer 27

Venous