1. Ulcerations Due to Peripheral Vascular Disease
Mark Finkelstein DPM
Board-Certified, American Board of Podiatric Surgery
Board-Certified, American Board of Podiatric Medicine

2. 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

3. Arterial Ulcer Characteristics
Located on bony prominences of the legs and feet
“Punched-out” appearance with well-defined borders
Shiny atrophic skin, no hair growth
Little/no edema or wound exudate
Yellow slough or black eschar in the wound bed with little granulation tissue
Feet are cool to touch and pedal pulses are often not palpable

4. Arterial Ulcer Characteristics

5. Assessment of Pedal Pulses

6. Vascular Assessment-Clinical
Elevation Pallor
Dependent Rubor

7. 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

8. Treating The Arterial Wound
Do not debride dry, stable eschar until perfusion status is determined
For ulcers with insufficient flow, maintain dry, stable eschar

9. 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

10. Vascular assessment
Noninvasive vascular testing

11. Vascular Assessment
Evaluate vascular status with angiogram

12. Vascular treatment
Endovascular- Techniques

13. Vascular treatment
Surgical Bypass-

14. 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

15. Multidisciplinary approach
Medical therapy- beta blockers, statins, ACE inhibitors and antiplatelet therapy
2. Teach chronic disease management
3. Optimize nutrition
4. Tobacco cessation programs
5. Evaluate functional, cognitive and emotional state of the patient

16. Multidisciplinary approach
Increase regular exercise and physical activity to improve symptoms of claudication
Proper pain control of ulcerations

17. Arterial ulcers -Summary
Requires a multidisciplinary approach for proper management
Wound Care Specialist-Podiatrist, Wound Nurse
Vascular /Interventional Radiologist
Vascular surgeon
Primary Care Physician
Dietitian
Mental Health Provider
Orthotist
Physical Therapist
Pain Management Specialist

18. Arterial ulcerations
QUESTIONS
THANK YOU