Smoking cessation after lower extremity revascularization in the Vascular Quality Initiative
Warren J Carter1, Andrew W Schwartz1, Hannah Zwibelman2
1Yale School of Medicine, New Haven, CT.
Journal of Vascular Surgery
|March 13, 2026
Summary
Smoking cessation after lower extremity revascularization (LER) is decreasing, making it harder to quit. Efforts should target younger patients undergoing elective endovascular procedures for claudication.
Area of Science:
- Vascular Surgery
- Public Health
- Smoking Cessation
Background:
- Smoking cessation is vital for managing peripheral arterial disease (PAD) and improving vascular surgery outcomes.
- The Society for Vascular Surgery's CAN-DO campaign (2023) emphasizes smoking cessation in vascular care.
- Understanding trends and factors influencing smoking cessation post-lower extremity revascularization (LER) is critical for quality improvement.
Purpose of the Study:
- To analyze trends in smoking cessation rates among patients undergoing LER.
- To identify patient characteristics and procedural factors associated with continued smoking after LER.
- To evaluate the impact of smoking cessation on outcomes following LER.
Main Methods:
- Analysis of patients from the Vascular Quality Initiative (VQI) registries (PVI, INFRA, SUPRA) who were current smokers at the time of LER.
- Smoking status was assessed at long-term follow-up.
- Comparison of characteristics and outcomes between patients who continued smoking versus those who achieved cessation; survival analysis was employed.
Main Results:
- Prevalence of current smokers was highest in suprainguinal bypass (56%), followed by infrainguinal bypass (40%) and PVI (35%).
- Smoking cessation rates decreased significantly from 2010-2022 for both PVI and lower extremity bypass (LEB).
- Continued smoking post-LER was associated with younger age, male sex, socioeconomic disadvantage, COPD, elective surgery, claudication, and endovascular approach. Smokers had fewer perioperative complications but worse long-term outcomes.
Conclusions:
- Despite a decrease in the proportion of smokers undergoing LER, achieving smoking cessation has become more challenging.
- Targeted smoking cessation interventions are needed, particularly for younger patients undergoing elective endovascular LER for claudication.
- Further research into the complex relationship between smoking, perioperative complications, and long-term outcomes in PAD patients is warranted.
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