Cigarette smoking: acute main and small vessel hemodynamic responses in patients with arterial disease.

While cigarette smoking is a major risk factor in lower limb ischemia, not all smokers develop symptomatic lesions, which suggests an individual susceptibility. Using Doppler probes the acute main vessel response to smoking was quantified in terms of the pulse transit time delay. Patients with occlusive arterial disease had a significant shortening in the transit time delay, suggesting a stiffening in the main vessels in response to smoking not seen in control subjects without disease. In patients with occlusive disease the digital pulse volume recorder amplitude decreased significantly in response to both low and high nicotine cigarettes, and these patients tended to self-titrate their nicotine intake, suggesting that little is to be gained by switching from high to low nicotine cigarettes: rather, cessation of smoking should be considered. These preliminary results suggest that patients with atherosclerotic occlusive disease are more susceptible to cigarette smoking and that Doppler or pulse volume recorder testing may help identify those habitual smokers who are at risk.