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55be9034d4 Leg ulcers are debilitating and painful and greatly reduce patients' quality of life. The majority of venous ulcers are in the gaiter area and the majortiy of non-venous ulcers in foot Venous ulcers most commonly occur above the medial or lateral malleoli. Thrombolysis is often the best treatment as simple embolectomy or thrombectomy usually leads to early rethrombosis and surgical bypass is often precluded by obliteration of the distal run-off. FootnotesWe thank Professor C V Ruckley, Mr A Jenkins, and Mr J A Murie for help with the illustrations. Common sites of venous, arterial, and neuropathic ulceration. Pain on squeezing the calf indicates muscle infarction and impending irreversible ischaemia. If the syndrome is recognised and treated early then many patients gain prolonged relief from drugs or chemical or surgical sympathectomy. Subscribe My Account BMA members Personal subscribers My email alerts BMA member login Login Username * Password * Forgot your sign in details? Need to activate BMA members Sign in via OpenAthens Sign in via your institution Edition: International US UK South Asia Toggle navigation The BMJ logo Site map Search Search form SearchSearch Advanced search Search responses Search blogs Toggle top menu ResearchAt a glance Research papers Research methods and reporting Minerva Research news EducationAt a glance Clinical reviews Practice Minerva Endgames State of the art News & ViewsAt a glance News Features Editorials Analysis Observations Head to head Editor's choice Letters Obituaries Views and reviews Rapid responses Campaigns Archive For authors Jobs Hosted Education Ulcerated lower limb Ulcerated lower limb No markup for post-processing Clinical Review ABC of arterial and venous disease Ulcerated lower limb BMJ 2000; 320 doi: (Published 10 June 2000) Cite this as: BMJ 2000;320:1589 Article Related content Metrics Responses Peer review Nick J M London, Richard Donnelly Ulceration of the lower limb affects 1% of the adult population and 3.6% of people older than 65 years. A few hours can make the difference between death or amputation and complete recovery of limb function. They may also present with paraplegia due to ischaemia of the cauda equina, which can be irreversible.
AtheroembolismCholesterol emboli are shed from a complex, often acutely ruptured, atherosclerotic plaque. They may also arise from the left ventricle, heart valves, prosthetic bypass grafts, aneurysmal disease, paradoxical embolism, and atrial myxoma (rare). Even if no source of embolism is found, anticoagulation should continue long term. It is useful to divide leg ulcers into those occurring in the gaiter area and those occurring in the forefoot because the aetiologies in these two sites are different. 2000 Mar 18; 320(7237): 764767. Postoperatively the patient should continue to receive heparin to prevent formation of further emboli. Differentiation of embolus and acute arterial thrombosis (thrombosis in situ)Clinical featuresEmbolusThrombosisSeverityComplete (no  collaterals) Incomplete  (collaterals) OnsetSeconds or minutes Hours or days Limb affectedLeg 3:1 arm Leg 10:1 arm Multiple sitesUp to 15% Rare Embolic sourcePresent (usually atrial  fibrillation) Absent Previous claudicationAbsent Present Palpation of arterySoft, tender Hard, calcified BruitsAbsent Present Contralateral leg pulsesPresent AbsentDiagnosisClinical Angiography TreatmentEmbolectomy, warfarinMedical, bypass,  thrombolysis . Distribution of non-venous and venous ulcers of lower limb. Shares . Limb ischaemia is classified on the basis of onset and severity.