Wet gangrene in hemodialysis patients with calciphylaxisis is associated with a poor prognosis.
Calciphylaxis is a rare syndrome characterized by progressive vascular calcification and ischemic tissue loss in patients with chronic renal failure. We report our five-year experience with five patients who developed foot gangrene due to calciphylaxis. All five patients had characteristic clinical, laboratory, and radiologic findings of the disorder, but no diagnostic variable was uniformly present. All five had progressed to advanced gangrene at the time of surgical consultation. Despite aggressive local attempts to control infection, all five patients died of septic complications. Parathyroidectomy was performed in three patients but did not alter the course in any case. This small experience suggests that the outcome of foot gangrene associated with calciphylaxis is predicated on the degree of tissue loss. Aggressive local wound care does not appear to be adequate to control infection in patients who have already developed gangrene. Although parathyroidectomy may have important long-term advantages in patients with calciphylaxis, it does not appear to affect outcome in these advanced cases.
Davis
C A
CA
Division of Vascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75235-9031, USA.
Valentine
R J
RJ
D000328:Adult; D002115:Calciphylaxis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005528:Foot / Q000473:pathology*; D005734:Gangrene; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011379:Prognosis; D006435:Renal Dialysis; D012883:Skin Ulcer / Q000209:etiology / Q000473:pathology