1. Case Study: Venous Ulceration in Combination with Calciphylaxis Ron Bush, MD, FACS Midwest Vein & Laser Center Dayton, Ohio

2. Calciphylaxis From Nonuremic Causes: A Systematic Review

3. History 57- year old female Obese Non-Compliant with compression stockings 4-year history ulceration of left lower leg Medical History: rheumatoid arthritis Lab values: Normal except rheumatoid factor which is 48

4. Leg Ulcer

5. Ultra Sound Findings GSV insufficiency Large mid-calf incompetent perforator Incompetent perforator under ulcer bed No reflux femoral popliteal

6. Perforator Under Ulcer Bed

7. Initial Treatment Debridement of Wound Foam sclerotherapy to distal perforators Biopsy of ulcer using 1mm punch Compression dressing

8. Histology Findings Put Nicks report & screen shot of his report

9. Ultra Sound 4 Weeks Post Foam

11. Treatment to Date 2 more foam sclerotherapy sessions have been done with 1% Sotradecol ® foam Non-compliant with dressing Minimal healing of ulcer Cessation of flow of all but the smallest vessels under the ulcer bed

14. References