Investigations

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