Arterial ulcers

Question 1

ABPI interpretation: what do the different values indicate?

Answer 1

> 1.4 is uncompressable

1-1.4 is normal

0.9-0.99 may need further testing

0.9-0.5 likely PAD

<0.5 severe PAD, may be limb threatening

Question 2

What are the risk factors for arterial ulcers?

Answer 2

• Vasculopathic (HTN, PAD, hyperlipidaemia)
• T2DM - poor blood supply and peripheral neuropathy
• Age
• Personal history
• Malnutrition
• Smoking
• Obesity
• Immobility

RA can lead to vasculitis, causing arterial inflammation and occlusion.

Question 3

What is the pathology behind arterial ulcers?

Answer 3

Insufficient blood supply due to stenosis or occlusion (thrombosis) → low oxygen supply → poor wound healing/skin regeneration

This leads to the development of ulcers due to inadequate blood flow.

Question 4

Name the types of arterial ulcers.

Answer 4

• Atherosclerotic arterial ulcers
• Vasculitis
• Thromboembolic

Atherosclerotic ulcers are due to systemic atherosclerosis, while vasculitis involves inflammation of blood vessels.

Question 5

What are the signs and symptoms of arterial ulcers?

Answer 5

• Located on peripheries
• Punched out appearance - deep and painful
• Clear borders
• Pale and necrotic base
• Hair loss
• Cold peripherally
• Reduced/absent pulses
• Atrophy of subcutaneous tissue

These symptoms indicate reduced arterial supply.

Question 6

What investigations are used for arterial ulcers?

Answer 6

• Bedside: wound swab, peripheral vascular examination
• Bloods: FBC, blood cultures if septic, HbA1C, lipid profile, Vitamin B1+6, Coag profile
• Imaging: ABPI, Doppler US, MR angiogram

These investigations help assess the condition and underlying causes.

Question 7

What is the management approach for arterial ulcers?

Answer 7

• Supportive care
• Antibiotic (flucloxacillin to prevent infection)
• Wound dressing and care
• Treatment of the cause

Management focuses on preventing infection and addressing underlying issues.

Question 8

True or false: The prognosis for arterial ulcers indicates they are unlikely to reoccur.

Answer 8

FALSE

Arterial ulcers are likely to reoccur, indicating an underlying pathology.

Question 9

What are the differential diagnoses for arterial ulcers?

Answer 9

• Venous ulcers
• Neuropathic ulcers

Venous ulcers typically have sloughy edges and are less painful, while neuropathic ulcers are associated with T2DM and lack of sensation.