Age, Diabetes and Smoking in Lower Limb Amputation for Arterial Occlusive Disease

Persistent Depressive Symptoms and Functional Decline Among Patients With Peripheral Arterial Disease

“…For example, significant comorbidities may be expected to be associated with decline in functioning (23). Smoking has been shown to be associated with progression of PAD (24,25). Exercise, BMI, ABI, and leg symptoms have been shown to be associated with functional impairment or decline, or both (3,4,23,26,27).…”

The Peripheral Vascular Consequences of Smoking

“…Because diabetic patients have a two-to threefold excess risk of atherosclerotic complications compared with nondiabetics, the absolute increase in risk attributable to smoking is much greater among diabetics [32]. Thus, amputation is particularly likely to be needed in diabetics with peripheral vascular disease who smoke [30,33]. Other adverse outcomes are more frequent in claudicants who continue to smoke cigarettes, including death, myocardial infarction, and stroke [34,35].…”

Statement on smoking and cardiovascular disease for health care professionals. American Heart Association.

“…The most severe cases of peripheral vascular disease may result in loss of the affected limb, and smokers are at increased risk of limb amputation consequent to peripheral artery disease. 23 Smokers are twice as likely to develop leg pain suggestive of peripheral artery disease during exercise testing and have an increased risk of intermittent claudication.24 In the Framingham Study the risk of intermittent claudication was four times greater in heavy smokers than in nonsmokers. 25 In reconstructive arterial surgery of the lower extremities, smokers have higher rates of graft occlusion than nonsmokers.1 The promotion of atherosclerosis by cigarette smoking is most pronounced in the aorta, causing a significantly increased risk of aortic aneurysm.…”