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Assessing Arterial Ulcers

January 24, 2013

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Arterial ulcers can cause much pain for patients and consternation for the wound care professionals tasked with managing them. Arterial ulcers can be a catch-22 in that many patients with arterial ulcers present with edema, but due to the nature of their problem cannot be safely compressed.

Management of arterial ulcers starts with recognition of the problem. Identifying arterial disease can be tricky but is crucial - failure to recognize the presence of arterial disease can have serious consequences for the patient.

Arterial ulcers typically appear on the foot (dorsum, lateral malleolus) or toes. They may appear where an area of pressure is present. You may note that the affected leg and foot are pale, cool to touch and hairless. Pulses may be absent or diminished. There may be dependent edema of the affected limb, and blanching on elevation of the limb may be noted. The ulcer itself often has a "punched out" appearance and may be deep or shallow; necrotic tissue may be present. The wound may lack granulation tissue and the wound base is often pale.1 The patient may complain of pain in the affected limb during exercise and/or upon elevation of the extremity. Pain may also occur at rest and is often relieved when the limb is placed in a dependent position.

You will want to obtain the patient’s history, which may include smoking, peripheral vascular disease, diabetes, obesity, dyslipidemia, and/or hypertension. Ask the patient about their mobility and activity level. Query the patient regarding adequacy of their diet and assess nutritional status. Assess pain and any issues with performance of ADLs/quality of life. Ask about previous episodes of ulceration and previous treatments. The wound should be assessed in the same manner as all wounds.

Ankle-brachial index (ABI) is used to measure peripheral tissue perfusion. When pulses are difficult to palpate, Doppler ultrasound can be used. Diagnosis of an arterial ulcer is made through a combination of the patient’s history, appearance and characteristics of the wound and the ABI results. The lower the ABI result, the more likely it is that the patient might require a revascularization procedure or amputation.2

1. Hess C. Arterial ulcer checklist. Advances in Skin & Wound Care. 2010;23(9): 432.
2. Meyers B. Wound Management (2nd edition). Upper Saddle River, New Jersey: Pearson Prentice Hall; (2008): 234.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.