Ulcerations Due to Peripheral Vascular Disease
Mark Finkelstein DPM
Board-Certified, American Board of Podiatric Surgery
Board-Certified, American Board of Podiatric Medicine
Comprehensive Assessment
Complete History and Physical- claudication?, Rest pain, night pain? History of smoking?
Lower extremity examination-always check between the toes
Wound assessment-infection,size,depth,exudate,base
Vascular assessment-Pulses, Non Invasive testing, Angiogram
Arterial Ulcer CharacteristicsLocated on bony prominences of the legs and
feet“Punched-out” appearance with well-defined
bordersShiny atrophic skin, no hair growthLittle/no edema or wound exudateYellow slough or black eschar in the wound
bed with little granulation tissueFeet are cool to touch and pedal pulses are
often not palpable
Arterial Ulcer Characteristics
Assessment of Pedal Pulses
Vascular Assessment-Clinical
Elevation Pallor
Dependent Rubor
Treatment of Arterial Disease•Refer for vascular evaluation•Cardiovascular disease should be identified and managed
•Recommend tobacco cessation
• Increase regular exercise to improve symptoms of claudication
Treating The Arterial Wound
•Do not debride dry, stable eschar until perfusion status is determined
•For ulcers with insufficient flow, maintain dry, stable eschar
Treating the Arterial Wound•For ulcers with sufficient arterial flow, implement moist wound healing, enzymatic debridement and proper offloading•Treat infection promptly -consider Infectious Disease Consult
Vascular assessment•Noninvasive vascular testing
Vascular Assessment• Evaluate vascular status with angiogram
Vascular treatment•Endovascular- Techniques
Vascular treatment•Surgical Bypass-
Evaluate risk factors for atherosclerosis•Smoking, diabetes, hypertension, hypercholesterolemia, advanced age, obesity, family history
•Review of labs to identify risk markers –elevated total cholesterol, triglycerides and reduced high density cholesterol
Multidisciplinary approach1. Medical therapy- beta blockers, statins,
ACE inhibitors and antiplatelet therapy
2. Teach chronic disease management
4. Tobacco cessation programs
3. Optimize nutrition
5. Evaluate functional, cognitive and emotional state of the patient
Multidisciplinary approach
• Increase regular exercise and physical activity to improve symptoms of claudication
• Proper pain control of ulcerations
Arterial ulcers -SummaryRequires a multidisciplinary approach for proper management
1. Wound Care Specialist-Podiatrist, Wound Nurse2. Vascular /Interventional Radiologist3. Vascular surgeon4. Primary Care Physician5. Dietitian6. Mental Health Provider7. Orthotist8. Physical Therapist9. Pain Management Specialist
Arterial ulcerations
QUESTIONS
THANK YOU
