Transcript Arterial and Venous Ulcers

Arterial and Venous
Ulcers
Presented by
Amelia E. Quiz
Emory University
Objectives
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Define arterial and venous ulcer through:
 Disease etiology
 Patient’s history
 Clinical presentation
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Discuss assessment and diagnostic
components.
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Determine management or treatment
strategies.
ARTERIAL ULCERS
 Ulcers resulting from
peripheral arterial
disease (PAD).
VENOUS ULCERS
 Ulcers resulting from
venous insufficiency
or venous HTN.
DISEASE EPIDEMIOLOGY:
 Increases with age
ARTERIAL ULCERS
 Greater among men
(CDC, 2002)
DISEASE EPIDEMIOLOGY:
VENOUS ULCERS
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Incidence and prevalence have
not been well established (5).
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Greater among women (2).
Increases with age (65 & older)
(5).
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The prevalence of venous ulcer
varies greatly (4).
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Unhealed venous ulcer is
approximately 0.3%,
i.e. about 1 in 350 adults (2).
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70% of chronic
ulcers of the lower limbs
(2).
Impact on the Quality of Life
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Affects lifestyle
Inability to work
Social isolation
Frequent hospitalizations or clinic visits
Feelings of anger and resentment
DISEASE ETIOLOGY:
Risk factors
ARTERIAL ULCERS
 Atherosclerosis
 Hx of MI or CVA
 Hyperlipidemia
 DM
 Tobacco use
 Hypertension
 Hyperhomocystinemia
VENOUS ULCERS
 DVT
 Obesity
 Multiple pregnancies
 Limited ROM ankle
joint
 Sedentary lifestyle
 Thrombophilia
Pt’s. history, Focused PE,
Symptoms and Complaints
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Ulcer History
Onset
Duration
Prior treatment
Response to
treatment
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Pain History
Severity
Description
Exacerbating factors
Relieving factors
Location
Clinical Presentation of Arterial Ulcers
 Location –distal aspect of
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extremity, pressure points
of the foot, area of trauma
Wound size & shape –
small craters; well-defined
borders (punched out)
Wound bed – pale or
necrotic
Exudate – minimal or dry,
no edema
Surrounding skin – faint
halo of erythema or slight
fluctuance. Gangrene,
necrosis or infection is
common
Increased pain &
tenderness
Clinical Presentation of Arterial
Ulcers (cont’d)
Clinical Presentation of Venous Ulcers
 Location – gaiter area,
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particularly medial
malleolus
Wound edges and depth –
irregular edges and shallow
Wound bed – ruddy red;
yellow adherent or loose
slough; undermining or
tunnels uncommon
Exudate – large
Surrounding skin –
macerated, crusted,
scaling, hemosiderosis,
edema, dermatitis
Pain – variable (dull,
aching or bursting)
Clinical Presentation of Venous
Ulcers (cont’d)
ASSESSMENT AND
DIAGNOSTICS
PHYSICAL EXAM
 Vascular Assessment
 Sensorimotor Assessment
 Ulcer Assessment
Vascular Assessment
 Color/response to
elevation and
dependency
 Temp./warmth
 Status of skin/hair/nails
Vascular Assessment (cont’d)
 Pulses – venous and
capillary refill
 Edema
Vascular Assessment (cont’d)
 ABI
Sensorimotor Assessment
 Response to 5.07
monofilament
 Vibratory
response
 Position sense
Sensorimotor Assessment (cont’d)
 Toe/Foot deformities
 Gait/Wear patterns of footwear
Ulcer Assessment
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Location
Dimensions & depth
Appearance/color or
wound bed
Status of wound
edges
Volume of exudate
Status of surrounding
tissue
DIAGNOSTICS
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LAB WORK-UP
CBC
ESR
FBS
Serum Albumin &
transferrin levels
DIAGNOSTICS
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Arterial Ulcers
Arterial duplex
ultrasound
(cont’d)
DIAGNOSTICS
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Arterial Ulcers
Plethysmography
Transcutaneous
pressure of oxygen
(TcPO2)
(cont’d)
DIAGNOSTICS
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Venous Ulcers
Color duplex
ultrasound scanning
(cont’d)
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment)
ARTERIAL ULCERS
 Surgical options
 Hyperbaric O2 Tx
 Pharmacologic Tx
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment) cont’d
ARTERIAL ULCERS
 Behavioral strategies
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment) cont’d
ARTERIAL ULCERS
 Topical Therapy
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment)
VENOUS ULCERS
 Surgical options
 Limb elevation
 Pharmacologic
Therapy
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment) cont’d
VENOUS ULCERS
 Compression Therapy
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment) cont’d
VENOUS ULCERS
 Topical Therapy
Guidelines for Management
(Etiology, Systemic Factors & Topical Treatment) cont’d
VENOUS ULCERS
 Bioengineered Tissue
Case studies
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65 y/o obese female,
retired nurse
H/O multiple pregnancies,
DVT
CC –Swelling and aching
pain on bil. Lower ext.,
pain is worse toward the
end of the day. Relieved
by elevation.
PE – Lower ext. - Edema,
erythema, scaling,
hemosiderosis
Diagnostics
Treatment plan
Case studies
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58 y/o male, auto
mechanic
H/O smoking, DM2, HTN,
FH of MI & CVA
CC – Before, “pain” on
the lower extremities
while walking that is
relieved by rest; now pain
is present even at rest.
PE – Lower Ext - barely
palpable pulse, pain,
pallor, poikilothermia
(cold), necrosis
Diagnostics
Treatment
References
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(1)Bryant, R. (2000). Acute and chronic wounds. Nursing
management. (2nd ed.) St. Louis, MO: Mosby.
(2) CDC Data & Trends (2005). Retrieved April 5, 2007 from
http://www.cdc.gov/diabetes/statistics/hosplea/fig4.htm
(3) Fernandes Abbade, Luciana P., & Lastória, Sidnei (2005).
Venous ulcer: epidemiology, physiopathology, diagnosis and
treatment International Journal of Dermatology. 44 , 449 –456
(4) Fowkers FGR, Evans CJ, Lee AJ. Prevalence and risk factors
of chronic venous insufficiency. Angiology 2001; 52 : S5–S6.
(5) Margolis, DJ., Bilker, W., Santanna, J., Baumgarten, M.
(2002). Venous leg ulcer: incidence and prevalence in the
elderly. J Am Acad Dermatol. Mar;46(3):381-6.
Donnelly, Richard, Hinwood, David & London, Nick J M (2000).
ABC of arterial and venous disease: Non-invasive methods of
arterial and venous assessment. StudentBMJ. August 08:259302.
That’s all folks!!!