Calciphylaxis and nonhealing wounds: The role of the vascular surgeon in a multidisciplinary treatment Mira Milas, MDa, Ruth L. Bush, MDb, Peter Lin,

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Presentation transcript:

Calciphylaxis and nonhealing wounds: The role of the vascular surgeon in a multidisciplinary treatment Mira Milas, MDa, Ruth L. Bush, MDb, Peter Lin, MDc, Kathy Brown, RNd, Greg Mackay, MDe, Alan Lumsden, MDc, Collin Weber, MDf, Thomas F. Dodson, MDf Journal of Vascular Surgery Volume 37, Issue 3, Pages 501-507 (March 2003) DOI: 10.1067/mva.2003.70 Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Characteristic appearance of calciphylaxis wound with superficial ulceration and thick black eschar covering underlying necrotic tissue. Journal of Vascular Surgery 2003 37, 501-507DOI: (10.1067/mva.2003.70) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Arteriogram shows diffuse aortoiliac disease and left superficial femoral artery occlusion in patient with calciphylaxis ulcers of left lower leg. Patient underwent left femoral-popliteal bypass with reversed saphenous vein graft, followed by wound debridement and parathyroidectomy. Journal of Vascular Surgery 2003 37, 501-507DOI: (10.1067/mva.2003.70) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Hyperplasia of all parathyroid glands is prominent in secondary hyperparathyroidism seen in patients with calciphylaxis. Radical resection leaving small parathyroid remnant is guided with intraoperative PTH measurement. Less complete resection risks persistent and recurrent hyperparathyroidism and failure to improve extremity wounds. Parathyroid designations: LL, left lower; LU, left upper; RL, right lower; RU, right upper; SR, subtotal resection. Journal of Vascular Surgery 2003 37, 501-507DOI: (10.1067/mva.2003.70) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Complete ulcer healing was observed in all patients by 4.8 ± 2 months. Two patients, including one shown, needed skin grafting for tissue coverage. Journal of Vascular Surgery 2003 37, 501-507DOI: (10.1067/mva.2003.70) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 Multidiscliplinary treatment algorithm for calciphylaxis. Surgical procedures can be coordinated during same hospitalization. Vascular surgeon may also be important in assessing need for initial wound debridement and subspecialty referrals. Journal of Vascular Surgery 2003 37, 501-507DOI: (10.1067/mva.2003.70) Copyright © 2003 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions