The role and success of peripheral vascular surgery in patients with end-stage renal disease (ESRD) remains controversial. Reduced survival, higher mortality, and lower limb salvage rates have led some authors to advocate primary amputation in this patient population. Until recently, the explanation for high failure and mortality in these patients could not be explained. The authors report five patients with ESRD initially diagnosed with acral gangrene secondary to calciphylaxis. Despite distal gangrene, only three of the five patients had significant peripheral arterial insufficiency. Poor surgical results in ESRD patients developing peripheral vascular disease (PVD) can sometimes be explained on the basis of calciphylaxis.
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