Arterial ulcers Flashcards
(21 cards)
What are the risk factors for arterial ulceration?
Smoking, DM, HTN, dyslipidaemia, hyperhomocysteinemia. common manifestation of atherosclerosis
What is the pathogenesis of arterial ulceration?
Lack of blood perfusion leads to tissue necrosis, impeding wound healing due to insufficient oxygen and nutrients
What often precipitates arterial ulceration?
Trauma
What percentage of patients with peripheral arterial disease are symptom free?
Most
What is the earliest and most common presenting symptom of PAD?
Intermittent claudication
What symptoms may occur with disease progression in PAD?
Pain at rest, especially when legs elevated in bed at night
Describe the characteristics of arterial ulcers.
Round with sharply demarcated border, absence of bleeding, often over bony prominences of lower limbs
What is the typical wound pain pattern for arterial ulcers?
Exacerbated by limb elevation
What are some associated features of arterial ulcers?
Absent pedal pulses, cool feet, pallor of feet with elevation, redness with lowering (dependent rubor), sluggish cap refill, thickened nails, absence of toe hair, shiny atrophic skin,
What differentiates venous ulcers from arterial ulcers?
Location, pain characteristics, and surrounding skin condition
What are Martorell hypertensive ischemic ulcers?
Result from arteriosclerosis, typically located on posterolateral leg, with excruciating pain and treatment resistant HTN
What is Buerger disease?
A condition where ulcers can occur distally on both upper and lower extremities, with smoking as a risk factor
What does ABI stand for in the diagnosis of arterial ulcers?
Ankle-Brachial Index
What is the normal range for ABI?
0.91 – 1.3
What ABI value indicates PAD?
<0.9
What Ix for arterial ulcer diagnosis?
- ABI
○ Systolic BP of ankle/systolic BP of arm
○ Normal ABI = 0.91 – 1.3 (<0.9 = PAD) - Duplex USS
- Other: CTA/MRA;
gold standard is invasive digital subtraction angiography, but being replaced by CTA/MRA as non-invasive
What is the main goal of treatment for arterial ulceration?
Restoration of peripheral arterial flow
What are two types of endovascular interventions for treating arterial ulceration?
Percutaneous angioplasty, stent placement
What is an example of invasive reconstruction for arterial ulcer treatment?
Femoral popliteal bypass
What is a major difference in ulcer management for arterial ulcers compared to venous ulcers?
Avoid sharp debridement and VAC dressings
What additional interventions are recommended for arterial ulceration?
Smoking cessation, antiplatelet drugs, treatment of DM, HTN, dyslipidaemia
