Peripheral Vascular Disease Flashcards
RFs for venous ulcers?
Varicose veins Prev DVT Phlebitis Prev fracture, trauma or surgery FH Venous insufficiency Obesity
What is the major background RF for venous leg ulcers?
Venous insufficiency - leg pain, heavy legs, oedema, ache/itch, skin breakdown or pigmentation, eczema
Symptoms of venous insufficiency?
Leg pain
Heavy legs, oedema
Itching
Skin breakdown/eczema, pigmentation change
RFs for arterial leg ulcers?
Hx of arterial disease - CVD, CVA, HTN, PAD (intermittent claudication)
DM
Smoking
Obesity, immobility
Describe what venous ulcers look like?
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
What pain may be experienced in association with venous ulcers?
Venous insufficiency pain - eased by elevation
Where are venous ulcers typically found?
Circumference of lower leg, often distribution of medial saphenous venous system (mid calf down to malleoli)
What ulcer is typically shallow and has a moist, pink granulation base with irregular borders?
Venous
If handling causes oozing, what type of ulcer does that suggest?
Venous
What do arterial ulcers look like?
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)
What pain may be associated with arterial ulcers?
Intermittent claudication
Or nocturnal pain which is eased by dangling leg over bed
Signs of chronic limb ischaemia?
Pale Pulseless (diminished) Cold Painful Paraesthesia Paralysis/muscle wastage Hair loss/nail dystrophy
What ulcer is indicated by a well-defined, deep grey lesion on the dorsum of the foot?
Arterial
What is the typical appearance associated with neuropathic ulcers?
Punched out - deep
Under pressure points and surrounded by chronic inflammatory tissue
What ulcers are prone to painless, heavy bleeding on palpation?
Neuropathic
Possible presentations of diabetic ulcers?
Often a mixed picture as neuropathic, arterial and even venous components may contribute
However often over a bony prominence (in a known DM patient!)
How do hypertensive ulcers typically present?
Lateral aspect of leg, painful with necrotic edges
What is a normal ABPI?
Around 1
What does a raised ABPI generally suggest?
If there are ulcers present they are likely to be venous
May be due to calcification of arteries - atherosclerosis, DM
What type of ulcers are more likely to be present with a raised ABPI?
Venous
What does an ABPI of
Probably arterial disease - ulcers are likely to be arterial unless obviously clinically venous
What must be absolutely avoided in an ABPI of
Compression stockings
2 conditions that can give a ‘falsely raised’ ABPI?
Atherosclerosis
DM
Systemic vascular disease types of ulcers?
Rheumatoid ulcers
Systemic vasculitis associated (wegeners, SLE, scleroderma)
What must be excluded before giving compression devices for venous insufficiency symptoms?
DM, arterial disease (ABPI) and neuropathy
What medication can be used for chronic venous ulcers?
Pentoxyfilline
What are the most common type of leg ulcer?
Venous
