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Mixed arterial and venous leg ulcer — SCE Dermatology MCQ

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HardDressings & wound careMixed arterial and venous leg ulcerSCE Dermatology

A 79-year-old smoker has a painful lateral ankle ulcer with a punched-out edge and surrounding venous eczema. The ankle-brachial pressure index is 0.56 on the affected side and toe pressures are reduced. The ulcer is lightly exudative, with no malodour or spreading erythema. What is the most appropriate management step. What is the most appropriate treatment?

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Correct answer: E — Vascular assessment before high-compression therapy

The correct answer is E, vascular assessment before high-compression therapy. An ABPI of 0.56 with reduced toe pressures indicates significant peripheral arterial disease, and this range (0.5 to 0.8) is classically associated with a mixed arterial-venous ulcer rather than pure venous disease, even though venous eczema is present. Applying high compression in this setting risks precipitating critical limb ischaemia, tissue necrosis, or gangrene, because compression further reduces perfusion to an already compromised limb. Current UK practice mandates that any suspicion of arterial insufficiency, confirmed here by ABPI and toe pressures, triggers referral for vascular assessment (duplex, further imaging, or specialist opinion) before any high compression bandaging is started, and only reduced or modified compression under specialist supervision may later be considered if appropriate.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions