Arterial Disease Ulcers, Part 1: Clinical Diagnosis and Investigation

Weir, Gregory Ralph MBChB, MMed(Surg); Smart, Hiske MA, RN, PG Dip(UK); van Marle, Jacobus MBChB, MMEd(Surg); Cronje, Frans Johannes MBChB(UP), BSc(Hons), MSc

doi: 10.1097/01.ASW.0000453095.19109.5c
Features: Clinical Management Extra

PURPOSE: To provide information regarding the clinical diagnosis, assessment, and investigations related to arterial disease ulcers of the lower extremity.

TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

OBJECTIVES: After participating in this educational activity, the participant should be better able to:

1. Describe the etiology and pathophysiology of peripheral arterial disease (PAD) and arterial ulcers.

2. Identify the clinical features of PAD and arterial ulcers as a result of arterial insufficiency of the lower limb.

3. Compare assessment modalities to determine the extent of arterial insufficiency and appropriate interventions.

ABSTRACT: Arterial disease (peripheral vascular disease) is the result of narrowing of the blood vessel lumen. The classic clinical signs need to be recognized early before progression to arterial predominant disease and limb ischemia. Arterial ulcers or tissue breakdown can result from trauma, infection, or other etiologies with diabetes, smoking, increasing age, and hypertension the most important risk factors. Diagnostic testing starts with a palpable pulse with special investigation including handheld Doppler for ankle brachial pressure index ratios, segmental duplex leg Doppler waveforms, and more specialized procedures, including transcutaneous oxygen saturation.

Gregory Ralph Weir, MBChB, MMed(Surg), Certificate in Vascular Surgery, IIWCC (ZA) • Medical Director • Vascular and Hyperbaric Unit, Life Eugene Marais Hospital • Pretoria, South Africa Hiske Smart, MA, RN, PG Dip(UK), IIWCC (Toronto) • Nurse Manager • Wound Care and Hyperbaric Oxygen Therapy, King Hamad University Hospital • Muharraq Island, Kingdom of Bahrain• Jacobus van Marle, MBChB, MMEd(Surg) • Consultant Vascular Surgeon • Medical University of South Africa • Pretoria, South Africa Frans Johannes Cronje, MBChB(UP), BSc(Hons), MSc • Associate Medical Director • Baromedical Facility, Tygerberg Hospital • Western Provence, Cape Town, South Africa

All authors, staff, faculty, and planners, including spouses/partners (if any), in any position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least 14 of the 18 questions correctly.

This continuing educational activity will expire for physicians on September 30, 2015.

Editor’s note: Part 2 of this article series will appear in the October issue of Advances in Skin & Wound Care.

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