Gianmarco de Donato, Francesco Setacci, Maria Pia Borrelli, Pasqualino Sirignano, Giuseppe Galzerano, Alessandro Cappelli, Carlo SetacciDepartment of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, Siena, Italy.OBJECTIVES:
Endovascular treatment is being offered more and more to young patients with critical limb ischemia (CLI), but patency rates and outcomes have been reported as modest. This study assesses outcomes of endovascular revascularization in young CLI patients according to their smoking attitude.
METHODS: Outcomes after endovascular treatment performed from 2005-2012 were retrospectively revised in patients aged <50 years at the time of revascularization. Risk of re-intervention and limb loss were assessed according to timing of smoking cessation, adjusted for clinical confounders.
RESULTS: Percutaneous angioplasty was performed on 112 limbs of 86 patients with CLI (Rutherford category 4=19.7%; 5=70.5%; or 6=9.8%). Initial technical success rate was 98.3%. The median follow-up duration was 51 months. Overall, limb loss at 2 years was 8.9% (n=10), but 10.2% in patients who had smoked (9 of 88) vs. 4.2% in those who had not (1 of 24). Compared with the latter, risk-adjusted odds ratios were 3.3 (p=0.04), 2.8 (p=0.05) and 1.6 (p=0.1) for those whose timing of smoking cessation was categorized as current smoker, quit just after intervention and quit 3 months pre-operatively. Occurrence of re-intervention at 2 years was 22.3% (n=25) overall, but 25% in patients who had smoked (22 of 88) vs. 12.5% in those who had not (3 of 24). Compared with the latter, risk-adjusted odds ratios were 4.3 (p=0.01), 2.3 (p=0.03) and 1.2 (p=0.1) for those whose timing of smoking cessation was categorized as above.
CONCLUSIONS: Direct effects of smoking on peripheral arterial reactivity are considered to be responsible for premature failure after intraluminal treatment of CLI in young patients. Smoking cessation is presumed to be beneficial before endovascular treatment. Risks of limb loss and re-intervention after intervention are increased by smoking and mitigated gradually by pre-operative cessation.
AUTHOR DISCLOSURES: M. Borrelli: Nothing to disclose; A. Cappelli: Nothing to disclose; G. de Donato: Nothing to disclose; G. Galzerano: Nothing to disclose; C. Setacci: Nothing to disclose; F. Setacci: Nothing to disclose; P. Sirignano: Nothing to disclose.
Posted April 2013