Condition- Arterial Leg Ulcers

Question 1

What is an arterial leg ulcer?

Answer 1

• A localised area of damage and breakdown of skin due to inadequate arterial blood supply. Usually seen on the feet of patients with severe atheromatous narrowing of the arteries supplying the legs.

Question 2

List some risk factors predisposing people to Arterial Ulcers

Answer 2

• Coronary heart disease
• History of stroke or TIA
• Diabetes mellitus
• Peripheral arterial disease (e.g. intermittent claudication, critical limb ischaemia)
• Obesity and immobility

Question 3

List some signs and symtpoms of arterial ulcers

Answer 3

• Circular and well defined with “punched-out” appearance
• Distal- at dorsum of foot/ between toes. At pressure points
• Night Pain- improved by dangling feet off end of bed (PVD-critical limb ischaemia)
• Hairlessness on dorsum of foot
• Pale skin
• Nail dystrophy (thickening)
• Wasting of calf muscles
• Absent pulses

Question 4

List some appropriate investigations to conduct on a patient presenting with arterial ulcers

Answer 4

• BLOODS: lipid profile, fasting blood glucose, HbA1c
• BEDSIDE: ABPI (only if >0.8), ECG
• IMAGING:
  
  • CT/MRI Angiography
  • Duplex US- to assess vascular patency and suitability for bypass/recanalisation surgery

Question 5

Which part of the leg are arterial leg ulcers often found?

Answer 5

DITALLY- the dorsum of the foot/ in betweem toes