Arterial Insufficiency Ulcers Overview

Arterial Insufficiency Ulcers

• High pressure in the arterial system (120 mmHg) propels blood forward from arteries towards the heart.
• Pressure decreases as it moves distally toward capillaries.

Risk Factors for Arterial Insufficiency Ulcers

• Atherosclerosis
• Obesity
• Diabetes
• Smoking
• Hypertension
• Age
• Cardiovascular Disease (CVD)

Prognosis

• Good Prognosis: Ankle Brachial Index (ABI) > 0.5, toe pressure 50 mmHg, transcutaneous oxygen levels > 30 mmHg.
• Poor Prognosis: Wounds do not decrease in size or heal within 2 weeks
• Poor Prognosis: Referral to a vascular surgeon indicated.

Examining for Arterial Insufficiency

• All open wounds require a pulse examination
• Capillary Refill Test:
  • Pt position: supine or sitting
  • Normal: Blood returns in 3 seconds or less
  • Impaired Vascular Status: Blood returns after 3 seconds or more.
• Venous Filling Time:
  • Normal: 15-20 seconds
  • Arterial insufficiency: Greater than 15-30 seconds
• Rubor of Dependency Test:
  • Normal: Foot color returns in 15 seconds
  • Arterial insufficiency: Color returns after 30 seconds and turns bright red.

Wound Care

• Infection Control
  • Ischemic wounds are prone to bacterial infection
  • Consider bacterial swab if classical signs are not present
  • Topical treatments: Silver dressings, cadexomer iodide
  • Deep tissue infection: Systemic antibiotic therapy
• Wound Cleansing:
  • Use 0.9% saline for cleansing
• Dressing:
  • Minimal exudate for arterial ulcers
  • Fragile surrounding skin on arterial ulcers
  • Moist, non-adherent dressing with antimicrobial properties.
• Precautions:
  • Avoid high compression (30-40 mmHg) with ABI greater than 0.80
  • Avoid compression dressings for patients with ABI greater than 0.50.
  • Avoid using sharp objects to remove debris in patients with low ABI.
  • Refer to a vascular surgeon if a patient has an ABI less than 0.50.