title: Is thromboangiitis obliterans presentation influenced by cannabis addiction?
abstract: BACKGROUND
  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.
  
  
  METHODS
  All consecutive patients presenting with a definite TAO were retrospectively reviewed according to their tobacco and cannabis consumption status.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Martin-Blondel
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Damien
authors.initials: D
authors.lastname: Sène
mesh_terms: D000328:Adult; D017668:Age of Onset; D000671:Amputation, Surgical; D018450:Disease Progression; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D023821:Limb Salvage; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008385:Marijuana Smoking / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013919:Thromboangiitis Obliterans / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents