Is thromboangiitis obliterans presentation influenced by cannabis addiction?

Cannabis implication in the pathophysiology of distal arteritis remains controversial. The aim is to assess whether cannabis co-exposure influences presentation and outcome of thromboangiitis obliterans (TAO) in tobacco smokers.

All consecutive patients presenting with a definite TAO were retrospectively reviewed according to their tobacco and cannabis consumption status.

A total of 38 patients with a definite TAO were included in this study. In all, 10 patients (26%) used tobacco together with cannabis (δ9-trans-tetrahydrocannabinol [THC], THC(+)), whereas 28 patients (74%) were only tobacco smokers (THC(-)). Tobacco exposure was comparable in both groups (21.7 ± 12 vs. 26.7 ± 17 pack-years). THC(+) patients were younger than THC(-) patients at onset of symptoms (28.5 ± 7 years vs. 36.6 ± 10.5 years, p = 0.02) and have more frequently unilateral involvement of lower limbs (44% vs. 7%, p = 0.02). Although 66% of patients presented with critical ischemia of lower limbs, THC(+) patients exhibited more often rest pain without ischemic ulcers (50% vs. 5%, p = 0.048). Upper limbs were clinically affected in 50% of THC(+) patients and 32% of THC(-) patients. Repeated infusions of iloprost were required in 84% of patients. Outcome and rate of minor and major amputations (10%) did not differ between groups.

Cannabis exposure influences the age at onset and presentation of TAO, but not the outcome. The data of present study suggest that cannabis represent a co-factor of tobacco that may accelerate TAO onset and presentation.