Vascular assessment

Perform vascular assessment for patients with a lower-limb ulcer to assess circulation. Vascular assessment starts with a detailed clinical examination as described in Examining the leg.

Venous incompetence must be identified because it can cause a wound or contribute to delayed healing. Refer patients with a leg ulcer or a wound with delayed healing for a comprehensive venous duplex scan for incompetence (obstruction and insufficiency). A duplex scan determines the competence of the patient’s valves and veins. The referral must be clear, otherwise the assessment may only look for venous thrombosis (ie deep vein thrombosis [DVT]). Ideally, scans are undertaken by an experienced laboratory; liaise with the imaging centre to ensure the intended study is performed.

A Doppler is used to assess arterial waveforms, and to measure the ankle brachial pressure index (ABPI). The ABPI is the ratio of the ankle systolic blood pressure to the brachial systolic blood pressure. ABPI is usually required before compression therapy to exclude significant peripheral arterial disease; for detailed discussion, see Venous leg ulcers, Arterial leg ulcers and Compression therapy.

Perform all scans with bandages and dressings removed. Arrangements to reapply wound dressings following the scan may need to be made.