Arterial ulcers

Question 1

Define arterial 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

Explain the aetiology/risk factors of arterial ulcers

Answer 2

The ulcers are caused by a lack of blood flow to the capillary beds of the lower extremities

Risk Factors
Coronary heart disease
History of stroke or TIA
Diabetes mellitus
Peripheral arterial disease (e.g. intermittent claudication)
Obesity and immobility

Question 3

Summarise the epidemiology of arterial ulcers

Answer 3

22% of leg ulcers

Prevalence increases with age and obesity

Question 4

Recognise the presenting symptoms of arterial ulcers

Answer 4

Often DISTAL - at the dorsum of the foot or between the toes

Punched-out appearance
Often elliptical with clearly defined edges
The ulcer base contains grey, granulation tissue

NIGHT PAIN- hallmark of arterial ulcers
Pain is worse when supine (because arterial blood flow is further reduced when
supine)
Pain is relieved by dangling the affected leg off the end of the bed

Question 5

Recognise the signs of arterial ulcers on physical examination

Answer 5

Night pain
Punched-out appearance
Hairlessness
Pale skin
Absent pulses
Nail dystrophy
Wasting of calf muscle

Question 6

Identify appropriate investigations for arterial ulcers

Answer 6

Duplex ultrasonography of lower limbs - assess patency of arteries and potential for
revascularisation or bypass surgery

ABPI

Percutaneous angiography

ECG

Fasting serum lipids, fasting blood glucose and HbA1c (diabetes is a major risk factor)

FBC- anaemia can worsen the ischaemia