Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Treatment options for managing arterial ulcers in a primary care setting include:
- Urgent referral: Refer patients with arterial ulcers, especially those with chronic limb-threatening ischaemia, urgently to a vascular multidisciplinary team for assessment and management, as revascularisation may be required NICE CKS,NICE CG147.
- Pain management: Offer analgesia such as paracetamol and opioids depending on pain severity, with consideration of neuropathic pain treatments if present NICE CKS.
- Wound care: Maintain cleanliness of the ulcer, avoid strict aseptic technique but prevent cross-infection, and use appropriate dressings that are non-adherent and suited to the wound characteristics; debridement may be considered if necrotic tissue is present but should be done by trained professionals NICE CKS,NICE NG19.
- Secondary prevention and risk factor management: Address cardiovascular risk factors including smoking cessation, diabetes control, lipid management, blood pressure control, and encourage exercise to prevent disease progression NICE CKS,NICE CG147.
- Patient education: Provide tailored information about the condition, risks, treatment options, foot care, and lifestyle modifications to support shared decision-making and self-care NICE CKS,NICE CG147.
- Compression therapy: Generally contraindicated in pure arterial ulcers due to risk of worsening ischaemia; thus, compression should be avoided unless mixed aetiology is confirmed and managed by specialists NICE CKS.
In summary, primary care management focuses on initial wound care, pain control, risk factor modification, patient education, and prompt referral to vascular specialists for further assessment and possible revascularisation NICE CKS,NICE CKS,NICE CG147.