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Case Study: Venous Ulceration in Combination with Calciphylaxis Ron Bush, MD, FACS Midwest Vein & Laser Center Dayton, Ohio Slide 2 Calciphylaxis From Nonuremic Causes: A Systematic Review Slide 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 Slide 4 Leg Ulcer Slide 5 Ultra Sound Findings GSV insufficiency Large mid-calf incompetent perforator Incompetent perforator under ulcer bed No reflux femoral popliteal Slide 6 Perforator Under Ulcer Bed Slide 7 Initial Treatment Debridement of Wound Foam sclerotherapy to distal perforators Biopsy of ulcer using 1mm punch Compression dressing Slide 8 Histology Findings Put Nicks report & screen shot of his report Slide 9 Ultra Sound 4 Weeks Post Foam Slide 10 Slide 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 Slide 12 Slide 13 Slide 14 References