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La duración del abandono del tabaco está asociada con el riesgo de amputación después de la revascularización por

Warren J Carter¹, Andrew W Schwartz¹, Bauer Sumpio²

¹Yale School of Medicine, New Haven, CT.

Journal of vascular surgery

|September 5, 2025

Resumen

El abandono del tabaco durante 9 a 21 meses antes de la revascularización de las extremidades inferiores para la isquemia crónica que amenaza las extremidades (ICL) redujo significativamente el riesgo de amputación mayor. Dejar de fumar durante menos de 9 meses no mostró ningún beneficio en comparación con los fumadores actuales.

Palabras clave:

El desvío Isquemia crónica de las extremidades Endovasculares Enfermedad arterial periférica Dejar de fumar

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Área de la Ciencia:

Cirugía vascular
Medicina cardiovascular
Salud pública

Sus antecedentes:

El abandono del tabaco mejora los resultados después de la revascularización de las extremidades inferiores.
No está claro cuál es la duración óptima para dejar de fumar en pacientes con isquemia crónica que amenaza las extremidades.
La comprensión de la duración del cese afecta el rescate de la extremidad y los resultados del paciente.

Objetivo del estudio:

Investigar el impacto de dos períodos distintos de cesación del tabaquismo en los resultados de la ERL en pacientes con ITLC.
Comparar los resultados perioperatorios y de un año entre fumadores actuales y ex fumadores con períodos de cesación variables.

Principales métodos:

Se utilizaron datos de la Iniciativa de Calidad Vascular (VQI, por sus siglas en inglés) (2016-2024) para pacientes con ILC sometidos a ERL.
Se clasificó a los antiguos fumadores en "recientes" (1-9 meses de cesación) y "de un año" (9-21 meses de cesación).
La propensión de los empleados a fumar para comparar los resultados entre los fumadores actuales y los ex fumadores.

Principales resultados:

No hay diferencias significativas en las complicaciones perioperatorias entre los fumadores actuales y los ex fumadores.
Los antiguos fumadores que habían dejado de fumar entre 9 y 21 meses presentaron significativamente menos amputaciones importantes en comparación con los fumadores actuales.
La interrupción durante 9-21 meses se asoció de forma independiente con un menor riesgo de amputación mayor (RH=0,72).

Conclusiones:

Los resultados perioperatorios después de la LER para el CLTI son similares para fumadores actuales y ex fumadores.
El abandono del tabaco durante 9 a 21 meses antes de la ERL se asocia con una reducción de la amputación mayor a largo plazo.
Puede ser necesario un cese sostenido del tabaquismo, idealmente alrededor de 2 años, para obtener beneficios significativos en el rescate de extremidades en pacientes con ITLC.