Vascular Ulcers Flashcards
What is the primary cause of venous ulcers?
- Venous hypertension
- Chronic venous insufficiency
Venous ulcers are often associated with conditions that lead to increased pressure in the veins.
Describe the pathophysiology of venous ulcers.
Venous hypertension leads to plasma leaks from capillaries, increased fibrinogen, fibrin cuff deposits, hypoxia, and ulceration
This sequence impairs oxygen and nutrient delivery, contributing to ulcer formation.
Where are venous ulcers most commonly located?
‘Gaiter’ region
The ‘gaiter’ area is specifically posterior and proximal to the medial malleolus.
What are the common symptoms of venous ulcers?
Painful, irregular shape, features of venous insufficiency such as oedema, brown pigmentation, lipodermatosclerosis, venous eczema, varicose veins
Skin changes include atrophie blanche and hyperpigmentation.
What is the normal range for Ankle-brachial pressure index (ABPI)?
0.9-1.2
An ABPI below 0.9 indicates arterial disease, which is critical for managing ulcers.
What are the management strategies for venous ulcers?
1) Conservative lifestyle changes
2) Compression bandaging
3) Oral Pentoxifylline/Diosmin
4) Skin grafting if needed
Lifestyle changes include smoking cessation and weight loss.
List the risk factors for arterial ulcers.
- Peripheral arterial disease (PAD)
- Diabetes Mellitus (DM)
- Rheumatoid Arthritis
- Smoking
- Poor nutrition
- Elderly age
- Obesity
- Immobility
Each factor contributes to reduced blood flow and increased risk of ulceration.
What are the classifications of arterial ulcers?
- Atheroclerotic arterial ulcers - systemic athelosclrosis
- Vasculitic arterial ulcers - often AI e.g. SLE/RA
- Thromboembolic arterial ulcers - Embolus/Thrombus obstruction
Each classification is based on underlying causes such as systemic atherosclerosis or inflammation.
Where do arterial ulcers typically occur?
Distal areas such as toes or lateral malleoli
They often present with a ‘punched-out’ appearance.
What are the common symptoms of arterial ulcers?
- Pain (painful or painless due to neuropathy)
- Punched-out apperance
- Pulselessness
- Cool skin
- Hair loss
- Nail changes
- Atrophy of subcutaneous tissue
Symptoms are related to poor blood flow and tissue oxygenation.
What investigations are used for arterial ulcers?
Ankle-brachial pressure index (ABPI), capillary refill, Bruerger’s test, Doppler ultrasound, blood tests, tissue biopsy
ABPI is crucial for assessing arterial supply and guiding treatment.
What is the management for arterial ulcers?
- Conservative: weight loss, stop smoking, manage co-morbidities
- Medical: Clopidogrel/Aspirin, Atorvastatin
- Revascularisation: endovascular procedure or bypass surgery
- Wound care: moist environment, debridement
- Pain management
Management focuses on improving blood flow and wound care.
What are the complications associated with arterial ulcers?
- Local: infection, gangrene, limb amputation
- Systemic: sepsis, pain, iatrogenic complications
Understanding complications is vital for comprehensive care and prevention.
Fill in the blank: The _______ is critical for assessing the healing ability of ulcers.
Ankle-brachial pressure index (ABPI)
It helps determine if arterial disease is present and guides treatment decisions.
