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Preventing limb loss from smoking

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“You can’t reverse peripheral artery disease (PAD), but you can slow its progression,” explains Renato Briones, MD, chief, general and vascular surgery at Virtua Memorial. And smoking exacerbates the problem, increasing an individual’s risk of developing PAD by 10 to 15 percent. Frederick Fisher, MD, Virtua vascular surgeon, says: “Up to 10 percent of those with advanced PAD risk an amputation because of vascular insufficiency.”

The key is to convince patients to stop smoking early on in the disease process. Once severe PAD symptoms – claudication,pain at rest, ulcers or gangrene –develop, aggressive treatment such as angioplasty and stenting may be required or, in a worst case scenario, bypass surgery.

Dr. Fisher: “For more moderate disease, noninvasive treatments, such as smoking cessation and educating patients to exercise or walk are sufficient to re-stimulate blood flow to peripheral arteries.” For patients who quit smoking, the risk of limb loss drops to less than one percent.

“Primary care physicians, as well as podiatrists, should continue their aggressive patient education about the effect smoking has on the entire circulatory system,” says Dr. Briones. The risk of limb loss is even higher for a diabetic patient with PAD since neuropathy and higher leg blood pressures can mask PAD, making it more difficult to diagnose.