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Effect of Smoking on Restenosis during the 1st Year after Lower-Limb Endovascular Interventions¹

¹ From the Departments of Angiology (M.S., W.M., M.H., S.S., R.A., E.M.) and Laboratory Medicine (M.E., O.W.), University of Vienna, Medical School, Waehringer Guertel 18–20, A-1090 Vienna, Austria. Received July 10, 2003; revision requested September 29; revision received October 1; accepted November 6. Address correspondence to M.S. (e-mail: martin.schillinger@akh-wien.ac.at).

PURPOSE: To investigate whether smoking has an effect on recurrent lumen narrowing after percutaneous transluminal angioplasty (PTA) or stent placement in lower-limb arteries.

MATERIALS AND METHODS: A total of 650 patients (median age, 70 years; 389 men) with peripheral artery disease who underwent iliac artery PTA (n = 95), iliac artery stent placement (n = 83), femoropopliteal PTA (n = 406), or femoropopliteal stent placement (n = 66) were selected from a prospective database. Patients were categorized according to their preintervention smoking habits as nonsmokers (n = 352), light smokers (one to nine cigarettes daily) (n = 54), habitual smokers (10–20 cigarettes daily) (n = 82), or heavy smokers (>20 cigarettes daily) (n = 162). Multivariate Cox proportional hazards analysis was used to determine whether there was an association between smoking habits and restenosis (50%) in the treated vessel segment within 1 year after treatment.

RESULTS: Cumulative restenosis rates at 6 and 12 months according to patients’ smoking habits were 99 and 190 nonsmokers, 18 and 22 light smokers, 16 and 29 habitual smokers, and 26 and 47 heavy smokers, respectively (P < .001). Adjusted hazard ratios for restenosis in smokers compared with nonsmokers were 1.51 (95% CI: 0.92, 2.50) for light smokers, 0.49 (95% CI: 0.28, 0.87) for habitual smokers, and 0.46 (95% CI: 0.30, 0.71) for heavy smokers, indicating a reduced restenosis risk in patients who smoked 10 or more cigarettes daily. These patients had reduced restenosis rates after either iliac (P = .011) or femoropopliteal intervention (P = .009). However, endovascular treatment at a younger age, coronary artery disease, and history of myocardial or cerebrovascular infarction were more frequently found in smokers.

CONCLUSION: Smoking 10 or more cigarettes daily is associated with a reduced rate of intermediate-term restenosis after lower-limb endovascular interventions.

© RSNA, 2004

Index terms: Arteries, extremities, 92.128, 92.12983 • Arteries, restenosis, 92.454, 92.458 • Arteries, stenosis or obstruction, 92.721 • Arteries, transluminal angioplasty, 92.1282 • Smoking

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