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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Investigations

Venous ulcers are usually diagnosed clinically without additional vascular investigations (1). Suspicion of arterial disease requires a vascular workup.

  • Ankle Brachial Pressure Index (ABPI)
    • will identify the presence or absence of significant peripheral arterial disease (PAD)
    • compression therapy may be safely used in leg ulcer patients with ABPI≥0.8
    • patients with an ABPI of <0.8 should e referred for a specialist vascular assessment (2)

In addition the following investigations are carried out in venous ulcer patients:

  • serial measurement of the ulcer surface area - indicates the rate of healing or failure to progress
  • bacteriological swabbing
    • should only be taken where there is clinical evidence of infection e.g. - cellulitis, pyrexia, increased pain, rapid extension of area of ulceration, malodour, increased exudate
  • patch-testing using a leg ulcer series
    • for leg ulcer patients with associated dermatitis/eczema
  • biopsy
    • should be considered if the appearance of the ulcer is atypical or if there is deterioration or failure to progress after 12 weeks of active treatment

  • other tests
    • serum glucose (and, if elevated, HbA1c), cholesterol and triglycerides, iron, haemoglobin, erythrocyte sedimentation rate and differential leukocyte counts

Reference:

1. Bonkemeyer Millan S, Gan R, Townsend PE. Venous Ulcers: Diagnosis and Treatment. Am Fam Physician. 2019 Sep 1;100(5):298-305.

2. Scottish Intercollegiate Guidelines Network (SIGN) 2010. Management of chronic venous leg ulcers

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