Management Arterial Leg

Ulcers

IDA BAGUS BUDIARTA

Objectives

 Identify leg ulcer

 Identify difference arterial ulcer and venous ulcer
 Understand sign and symptom of arterial ulcer
 Identify etiology of arterial ulcer
 Apply management of arterial ulcer
 Recognize patient who will required vascular surgeon consultation
 What : Arterial ulcer ?

 Arterial ulceration is A
Ulcer due to a
reduced arterial
blood supply to the
lower limb
Etiology :
Etiology and Patofisiology
 When : suspect patient with Arterial
problem ?

 ULCER and PAIN

Pain with arterial ulceration

• Pain may be present at rest and may be alleviated by

hanging the foot over the side of the bed or sleeping in
a chair
• Pain usually begins distal to the obstruction, moving
proximally as ischemia progresses
• The ulcer itself is often painful
How : Clinical sign

• Arterial ulceration typically occurs over the toes, heels, and bony
prominences of the foot
• Ulcer appears “punched out,” with well demarcated edges and pale,
non-granulating, often necrotic base
• Surrounding skin may exhibit dusky erythema and may be cool to touch,
hairless, thin, and brittle, with a shiny texture
• Toe nails thicken and become opaque and may be lost
• Gangrene of the extremities may also occur
• Examination of the arterial system may show a decreased or absent pulse
in the dorsalispedis and posterior tibial arteries
Arterial ulcer over lower leg, with
associated skin changes typical of arterial
disease
Examination

 Basic : The ankle brachial pressure index is helpful in identifying peripheral

vascular disease in the absence of non-compressible vessels resulting from
vessel calcification or tissue oedema
 Advance :
 A duplex ultrasound scan : further information—on arterial occlusion,
stenosis, and areas of diffuse and continuous atheromatous disease
 Arteriography is the ideal investigation in preoperative planning, direct
assessment of the vascular anatomy of the lower limb
Ankle Brachial Index
Management

 Patient should stop smoking, control diabetes, hypertension, and

hyperlipidaemia
 Patients may find benefits from sleeping in a bed raised at the head end
 Patients should follow simple advice on foot and leg care
 Choice of wound dressings will be dictated by the nature of the wound
Management : Vascular Surgeon

 Increasing the peripheral blood flow by reconstructive surgery (for diffuse

disease) or angioplasty (for localised stenosis)  most likely affect the
healing process in arterial ulceration
 Operative indications for chronic ischemia include non-healing ulceration,
gangrene, rest pain, and progression of disabling claudication
Left Femoral Stenosis
Angioplasty / Stenting
Bypass Surgery

Native Bypass
Graft Prosthetic Bypass
Evaluation
After
Intervention
Summary
THANK YOU