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Medical Editor Malachi Sheahan III, MD

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| Carlo Dall’Olmo, MD | Alan M. Dietzek

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| James McKinsey, MD | Joseph Mills, MD | Erica L. Mitchell, MD, MEd, FACS

| Leila Mureebe, MD | Frank Pomposelli, MD | David Rigberg, MD | Clifford Sales, MD | Bhagwan Satiani, MD | Larry Scher, MD | Marc Schermerhorn, MD | Murray

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Letters to the editor vascularspecialist@vascularsociety.org

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Vascular Specialist is the official newspaper of the Society for Vascular Surgery and provides the vascular specialist with timely and relevant news and commentary about clinical developments and about the impact of healthcare policy. Content for Vascular Specialist is provided by BIBA News. Content for the news from SVS is provided by the Society for Vascular Surgery. | The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or the Publisher. The Society for Vascular Surgery and BIBA News will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services, or the quality or endorsement of advertised products or services, mentioned herein. | The Society for Vascular Surgery headquarters is located at 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | POSTMASTER: Send changes of address (with old mailing label) to Vascular Specialist, Subscription Services, 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | RECIPIENT: To change your address, e-mail subscriptions@bibamedical.com | For missing issue claims, e-mail subscriptions@bibamedical. com. | Vascular Specialist (ISSN 1558-0148) is published monthly for the Society for Vascular Surgery by BIBA News. | Printed by Ironmark | ©Copyright 2023 by the Society for Vascular Surgery represents a unique non-emergent vascular patient population that can require lower extremity bypass.

Smoking is known to increase complications, including poor wound healing and coagulation abnormalities, and have cardiac and pulmonary ramifications, said Patel. “Across specialties, elective surgical procedures are commonly denied to active smokers. Given the base population of active smokers with vascular disease, smoking cessation is encouraged but is not required the way it is in general surgery,” she explained.

The research team queried the Vascular Quality Initiative VISION database over a 16-year period to tackle the question of how actively smoking claudicants fare after elective lower extremity bypass. They then carried out two separate propensity score matches on patient records that included 609 (10%) never smokers, 3,388 (55.3%) former smokers, and 2,123 (34.7%) current smokers who underwent bypass for claudication. One analysis examined the outcomes of former smokers and compared these to outcomes achieved in patients who had never smoked. The second analysis contrasted outcomes between current smokers and former smokers. The primary outcome measures included five-year OS, limb salvage (LS), freedom from target lesion reintervention (FTR) and AFS.

Health gains don’t shift unless claudicants quit smoking

There were no differences recorded with respect to any of these measures between 497 well-matched pairs of former smokers and those who had never smoked.

The second analysis, which focused on ascertaining outcome differences between 1,451 well-matched pairs of current and former smokers, found that there was no difference in LS or FTR, but revealed “a significant increase in OS and AFS” in former smokers compared with current smokers, suggesting that giving up smoking reaps rewards in terms of both limb and life preservation.

“Our study found that former smokers have better OS and AFS when compared to current smokers, while former smokers mimic never smokers at five-year outcomes for OS, LS, FTR and AFS,” Patel averred.

Patel stated: “This study emphasizes that we as providers must spend more time and effort working with patients to quit smoking prior to elective lower extremity bypass in claudicants.”

Limitations of the study include that the database contained no information on the duration or intensity of smoking among the study population, and there were no available data on the rate of recidivism or the cause of death among those studied.

According to senior author Mahmoud Malas, MD, chief of Vascular and Endovascular Surgery at UCSD: “We have found through this Medicare-linked VQI VISION analysis that even quitting smoking at least one month prior to surgical intervention can change long-term outcomes. Former smokers do better than current smokers and mimic the results of patients who have never smoked. As vascular surgeons, we need to play a more active role in these discussions with our patients in the clinic and in referring patients to smoking cessation programs.”

In discussion that followed the presentation, Patel was asked to comment on whether she felt that the length of time from smoking cessation could be an additional avenue of study, in particular if that information could be conveyed to patients to arrive at a specific length of time that may confer a benefit.

“We just looked at the actual smoking status,” responded Patel, adding that if this could be linked to variables such as days since patients have quit smoking “that would be a great next step to see if there are some intervals such as six or eight weeks that provide the best drop off.”