URGO MEDICAL

We are currently seeing more and more mixed ulcers presenting a predominantly arterial component. This can be explained by ageing of the population affected by venous leg ulcers, who are more prone to concurrent arterial diseases.
To determine the predominant origin of a mixed ulcer and/or make sure that there is no arterial disease, the ankle-brachial pressure index (ABPI) is measured.

The ankle-brachial pressure index (ABPI) is defined as follows:

i.e.:

This measurement, which can be very easily performed as an ambulatory test using a continuous Doppler probe or Doppler ultrasound blood flow detector, is essential, since it is the best way of determining whether a patient has arterial insufficiency or not.

• In a healthy individual, the ABPI is 1.1.
• If the ABPI is between 0.9 and 1.3 : there is no arterial disease. If an ulcer is present, it is of purely venous origin.
• If the ABPI is between 0.7 and 0.9 : there is concurrent arterial disease. However the ulcer is predominantly venous in origin.
• If the ABPI is less than 0.7 : the ulcer is of predominantly arterial origin.
• In the event of an ABPI of more than 1.3, the measurement is not significant since this reflects an artery incompressibility problem.

In contrast with venous ulcers, arterial ulcers are usually “suspended” and are more likely to be located on the outside surface of the leg or on the dorsal surface of the foot. An ulcer of this type has clean edges and is deep (undermining) with little exudate, and the base is whitish in colour. There are often multiple arterial ulcers.

To determine the origin (arterial or venous) of an ulcer, it is necessary to perform a Doppler ultrasound examination and measure the ankle-brachial pressure index (ABPI).

The ulcer type that is currently on the increase is the mixed ulcer. This is due to ageing of the population and the development of ulcers in patients of an increasingly advanced age.