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The peripheral vascular consequences of smoking

  • General Review
  • Published:
Annals of Vascular Surgery

Abstract

Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary arteries. The likelihood of claudication, amputation, stroke, abdominal aortic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exerts its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypertension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vasopressin, and a thrombogenic balance of prostacyclin and thromboxane A 2.Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects that contribute to atherosclerosis. In addition to rheologic and hematologic changes from increased erythrocytes, leukocytes, and fibrinogen, smokers have alterations in platelet aggregation and survival that produce thrombosis. Considering the ubiquitous repercussions of this menace, vascular surgeons should play an active role in motivating their patients to quit smoking.

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Authors and Affiliations

  1. Division of Vascular Surgery, University of California, San Francisco

    William C. Krupski MD

  2. Department of Veter ans Affairs Medical Center, 94121, San Francisco, California

    William C. Krupski MD

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  1. William C. Krupski MD
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Krupski, W.C. The peripheral vascular consequences of smoking. Annals of Vascular Surgery 5, 291–304 (1991). https://doi.org/10.1007/BF02329389

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