The peripheral vascular consequences of smoking |
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Authors: | William C Krupski MD |
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Institution: | (1) Division of Vascular Surgery, University of California, San Francisco;(2) Department of Veter ans Affairs Medical Center, 94121 San Francisco, California;(3) Surgical Service (112G), 4150 Clement Street San Francisco VAMC, 94121 San Francisco, California |
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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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Keywords: | Peripheral vascular disease smoking atherosclerosis |
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