[10] Arterial Ulcers Flashcards Preview

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Flashcards in [10] Arterial Ulcers Deck (26)
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1
Q

What is an arterial ulcer?

A

An ulcer caused by reduction in arterial blood flow, leading to decreased perfusion to the tissues, and susbequent poor healing

2
Q

What are the risk factors for arterial ulcers?

A

Same as those for peripheral arterial disease, including;

  • Smoking
  • Diabetes mellitus
  • Hypertension
  • Hyperlipidaemia
  • Increasing age
  • Positive family history
  • Obesity and physical inactivity
3
Q

What are the causes of arterial ulcers?

A
  • Restriction to blood vessels due to peripheral vascular disease
  • Chronic vascular insufficiency
  • Vasculitis
  • Diabetes mellitus
  • Renal failure
  • Hypertension
  • Arteriosclerosis and atherosclerosis
  • Trauma
  • Limited joint mobility
  • Increasing age.
4
Q

What preceding history is likely in arterial ulcers?

A

Intermittent claudication or critical limb ischaemia (pain at night)

5
Q

What are the history features of an arterial ulcer?

A

The ulcer may be painful, and often develops over a long period of time with little or no healing. The pain is typically at night, and relieved by dangling the legs out of the bed

6
Q

How do arterial ulcers appear?

A

Initially they have irregular edges, but over time they may become clearly defined. The lesions are often small and deep, with a ‘punched out’ appearance, and gray or yellow fibrotic base.

7
Q

What happens on handling an arterial ulcer, for example debridement?

A

There is little or no blood

8
Q

Where do arterial ulcers most often occur?

A

Distal to sites of trauma, or in pressure areas e.g the heal

9
Q

What other signs of arterial insufficiency may be present with an arterial ulcer?

A
  • Cold limbs
  • Reduced or absent pulses
  • Necrotic toes
  • Hair loss
10
Q

How can pure arterial ulcers be differentiated from neuropathic ulcers?

A

Sensation is maintaiend

11
Q

What investigation is required in any suspected arterial ulcer?

A

ABPI measurement

12
Q

What can be done based on the ABPI measurement in arterial ulcers?

A

Can quantify the extent of any peripheral arterial disease

13
Q

What is a normal ABPI?

A

>0.9

14
Q

What ABPI is considered to be mild PAD?

A

0.9-0.8

15
Q

What ABPI is considered to be moderate PAD?

A

0.8-0.5

16
Q

What ABPI is considered to be severe PAD?

A

<0.5

17
Q

How can the anatomical location of any arterial disease be assessed?

A

By clinical examination and imaging,

18
Q

What imaging is done in the investigation of arterial ulcers?

A
  • Duplex ultrasound
  • CT angiography
  • MRA (magnetic resonance angiogram)
19
Q

What are the categories of management in arterial ulcers?

A
  • Conservative management
  • Medical management
  • Surgical management
20
Q

What is involved in the conservative management of arterial ulcers?

A

Lifestyle changes, including smoking cessation, weight loss, and increased exercise

21
Q

How can arterial ulcer patients be supported in exercise?

A

Specific supervised exercise programmes are available

22
Q

What is involved in the medical management of arterial ulcers?

A

Suitable pharmacological risk factor modification, including statin therapy, anti-platelet agents such as aspirin or clopidogrel, and optimisation of blood pressure and glucose

23
Q

What is involved in the surgical management of arterial ulcers?

A
  • Angioplasty, with or without stenting
  • Bypass grafting for more extensive disease
24
Q

How may non-healing ulcers despite good blood supply be managed surgically?

A

Skin reconstruction with grafts

25
Q

How can arterial ulcers be prevented?

A
  • Examine feet (especially between toes) and legs daily for any unusual changes in colour, or development of sores
  • Management of cardiovascular risk factors, e.g. smoking, blood pressure
  • Ensure footwear is properly fitted to avoid points of rubbing or pressure
  • Avoid crossing legs when sitting
  • Avoid sitting or standing for extended periods
  • Avoid cold temperatures
  • Protect legs and feet from injury and infection
26
Q

What are the complications of arterial ulcers?

A

If left untreated, arterial ulcers can lead to serious complications, including infection, tissue necrosis, and in extreme cases amputation of the affected limb