Society For Clinical Vascular Surgery

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A Chance for Lifestyle Modification? Improvement in Symptoms Following Intervention Results in Decreased Tobacco Use in Active Smokers with Lifestyle Limiting Claudication
Ian Schlieder, DO, Michele Richard, MD, Maria Barreras, BS, S. Vijayakumar, PhD, Joann Petrini, PhD, Alan Dietzek, MD.
Danbury Hospital, Danbury, CT, USA.

OBJECTIVES: It is generally perceived that claudicants who are active tobacco users have worse outcomes following endovascular intervention than those that do not use tobacco, similar to open surgical revascularization. We have previously reported our findings in this patient population and showed similar outcomes with respect to rate of reintervetion, time to reintervention and or surgical revascularization, limb loss, MI, stroke and death.. We wished to further our previous study by determining if active tobacco users had subjective durability of their intervention based on their overall perception of their quality of life. In addition, we wished to see if following a successful intervention, patients changed their behavior with respect to tobacco use. METHODS: A previously compiled database which identified patients who had undergone their first endovascular intervention between 2007-2011 for lifestyle limiting claudication was utilized. Only those patients that were active tobacco users at the time of intervention were included in the present study. The mean follow-up was 7.7 years. The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) and a modified version of the World Health Organization’s Global Adult Tobacco Survey were administered to this patient group. RESULTS: 47 patients met inclusion criteria. 17 patients had either expired(6) or were lost to follow up. The 30 remaining patients were administered both surveys. At follow up all had previously reported improvement in their claudication following intervention. At the time of survey, 70% reported either decreased tobacco use or complete cessation. Thirty percent of patients had no change in their smoking habits. Patients who continued daily smoking had an average VascuQoL-6 score of 15.2 ± 1.8 95% CI 3.5, occasional smokers 18.9 ± 1.2 95% CI 2.4, and patients who had completely quit 20.1 ± 0.9 95% CI 1.8 and this difference was statistically significant (p 0.017).
CONCLUSIONS: Endovascular intervention for lifestyle limiting claudication in active tobacco users demonstrated a greater likelihood of decreased tobacco use post procedure, with greater improvements in claudication as evidenced by higher VQOL scores in those patients. Furthermore, those patients with the highest VQOL scores completely quit tobacco use. Our study suggests that in active smokers relief of lifestyle limiting claudication may motivate patients to pursue a heathier lifestyle. Additional studies with greater numbers of patients are warranted to confirm these findings.

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