Active smoking is associated with higher rates of incomplete wound healing after endovascular treatment of critical limb ischemia

Kokkinidis, Damianos G.; Giannopoulos, Stefanos; Haider, Moosa; Jordan, Timothy; Sarkar, Anita; Singh, Gagan D.; Secemsky, Eric A.; Giri, Jay; Beckman, Joshua A.; Armstrong, Ehrin J.

doi:10.1177/1358863x20916526

Cited by 8 publications

(4 citation statements)

References 65 publications

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“…In a study including 264 patients with CLI, active smoking was associated with higher risk for incomplete wound healing during 6-month (HR: 4.54; 95% CI: 1.41–14.28; p = 0.012) and 9-month (HR: 2.32; 95% CI: 1.11–4.76; p = 0.026) follow-up. 106 Although the exact cause for this association is not fully understood, several mechanisms have been proposed to explain this observation, involving increased oxidative stress and endothelial dysfunction. 107 Nicotine acts as a direct vasoconstrictor, having an additive effect to decreased perfusion of the lower extremities and, as such, further impairing the process of wound healing.…”

Section: Smoking Cessationmentioning

confidence: 99%

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Giannopoulos

Armstrong

2021

Vasc Med

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Critical limb ischemia (CLI) constitutes the most advanced form of peripheral artery disease (PAD) and is characterized by ischemic rest pain, tissue loss and/or gangrene. Optimized medical care and risk factor modification in addition to revascularization could reduce the incidence of cardiovascular events and major adverse limb events, improving patients’ quality of life and promising higher survival rates. Adequate adherence to cardioprotective medications, including antithrombotic therapy (e.g. antiplatelets, anticoagulants), cholesterol-lowering agents (e.g. statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and smoking cessation should be strongly encouraged for patients with CLI. This review examines these guideline-recommended therapies in terms of cardiovascular and limb-related risk reduction in patients with CLI.

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Section: Smoking Cessationmentioning

confidence: 99%

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Giannopoulos

Armstrong

2021

Vasc Med

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“…CLTI patients may have a much higher risk of amputation and mortality compared to those with claudication [ 88 ]. Although the one-year risk of limb loss is excessively high at 30% and the five-year all-cause mortality is 50% in patients with CLTI [ 111 – 113 ], higher BMI is associated with lower rates of mortality in patients with lower extremity ulcers [ 114 ].…”

Section: Impact Of Obesity or Underweight Status On Disease Progressi...mentioning

confidence: 99%

Obesity and Peripheral Artery Disease: Current Evidence and Controversies

et al. 2023

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Purpose of Review Obesity is a significant public health problem and a major risk factor for the development and progression of atherosclerosis and its cardiovascular manifestations. Lower extremity peripheral artery disease (PAD) affects 3%–10% of the Western population and, if left untreated, can lead to devastating outcomes with both an increased risk of morbidity and mortality. Interestingly, the association between obesity and PAD remains debatable. Whereas it is well known that PAD and obesity frequently overlap in the same patients, many studies have demonstrated a negative association between obesity and PAD and a protective effect of obesity on disease development and progression, a phenomenon described as the “obesity paradox.” Possible mechanisms for this paradox may include genetic background, as assessed by mendelian randomization studies, adipose tissue dysfunction, and body fat distribution rather than adiposity, while other factors, such as sex, ethnicity, sarcopenia in the elderly population, or aggressive treatment of co-existing metabolic conditions in individuals with obesity compared to those with normal weight, could have some impact as well. Recent Rindings Few reviews and meta-analyses examining systematically the relationship between obesity and PAD exist. The impact of PAD development due to the presence of obesity remains largely controversial. However, the most current evidence, backed by a recent meta-analysis, suggests a potential protective role of a higher body mass index on PAD-related complications and mortality. Summary In this review, we discuss the association between obesity and PAD development, progression, and management, and the potential pathophysiologic mechanisms linking the two diseases.

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“…Cigarette smoking is a major risk factor for cardiovascular disease, stroke, and mainly PAD [ 12 ]. Tobacco use also has a strong correlation with CLTI [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing the Risk of Major Amputation in Patients with Diabetic Foot Ulcers Treated by Autologous Cell Therapy

Husáková

Bém

Fejfarová

et al. 2022

Journal of Diabetes Research

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Introduction. Autologous cell therapy (ACT) is one of the last options for limb salvage in patients with chronic limb-threatening ischemia (CLTI) and diabetic foot ulcers (DFU). However, some patients may still undergo a major amputation even after ACT, but the risk factors for this are not known. Therefore, the aim of our study was to assess the risk factors for major amputation in patients with CLTI and DFU during a 2-year follow-up after ACT. Methods. One hundred and thirteen patients after ACT were included in our study and divided into two groups: Group 1 with major amputation (AMP; n = 37 ) and Group 2 without amputation (nAMP, n = 76 ). The risk factors for major amputation were evaluated before ACT and included factors relating to the patient, the DFU, and the cell product. Results. The AMP group had significantly higher C-reactive protein (CRP) levels compared to the nAMP group (22.7 vs. 10.7 mg/L, p = 0.024 ). In stepwise logistic regression, independent predictors for major amputation were mutation of the gene for methylenetetrahydrofolate reductase (MTHFR) with heterozygote and homozygote polymorphism 1298 (OR 4.33 [95% CI 1.05-17.6]), smoking (OR 3.83 [95% CI 1.18-12.5]), and CRP > 10 mg / L (OR 2.76 [95% CI 0.93-8.21]). Lower transcutaneous oxygen pressure (TcPO2) values were observed in AMP patients compared to the nAMP group at one month (24.5 vs. 33.2, p = 0.012 ) and at 3 months (31.1 vs. 40.9, p = 0.009 ) after ACT. Conclusion. Our study showed that the risk for major amputation after ACT in patients with CLTI and DFU is increased by the presence of MTHFR heterozygote and homozygote gene mutations, smoking, and higher CRP at baseline. Lower TcPO2 at one and 3 months after ACT may also have a predictive value. Therefore, it is necessary to stop smoking before ACT, treat any infection, and, above all, consider antiaggregation or anticoagulant treatment after the procedure.

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Active smoking is associated with higher rates of incomplete wound healing after endovascular treatment of critical limb ischemia

Cited by 8 publications

References 65 publications

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Medical therapy for cardiovascular and limb-related risk reduction in critical limb ischemia

Obesity and Peripheral Artery Disease: Current Evidence and Controversies

Factors Influencing the Risk of Major Amputation in Patients with Diabetic Foot Ulcers Treated by Autologous Cell Therapy

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