Effects of cigarette smoking on outcome of femoral popliteal bypass for limb salvage

Abstract

A retrospective 5-year follow-up study of 83 femoral-popliteal bypass operations for severe ischemia (79 patients) is presented. There were no operative deaths. At one month, cumulative patency rates (CPR) and limb salvage rates (LSR) were 86.8% and 96.4% respectively. At 5 years, CPR, LSR and cumulative survival were 50%, 79.4% and 71.6% respectively. Post-operative smoking habits were strongly related to CPR and LSR. Smoking more than 5 cigarettes per day adversely affected CPR's. At 5 years, CPR of non-smokers and smokers of up to 5 cigarettes per day (47 patients) was 67.7% and for smokers of more than 5 cigarettes per day (32 patients) it was 44.7% (P less than 0.045). Smoking more than 15 cigarettes per day had an adverse effect on LSR's. Smokers of more than 15 cigarettes per day (17 patients) had a 5-year LSR of 58.5% compared with 89% for non-smokers and smokers of up to 15 cigarettes per day (62 patients) (P = 0.009). For 20 limbs requiring thrombectomy LSR was 100% at 1 year and 57.5% at 5 years. CPR's and LSR's were not significantly influenced by pre-operative smoking, diabetes, run off or level of distal anastomosis relative to the knee joint. Based on zero operative mortality and 96.4% limb salvage at 1 year, it is concluded that an aggressive approach toward revascularization for limb salvage is well justified in most patients.(ABSTRACT TRUNCATED AT 250 WORDS)