Smoker strategy

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Following your article, “Doctors defend treatment ban for smokers” (9 August), we wish to further clarify our approach to smokers with a condition called intermittent claudication, where it was suggested that they are being denied access to our vascular surgery clinics at Royal Infirmary of Edinburgh.

Intermittent claudication is caused by a mild form of peripheral arterial disease, which is a narrowing of the arteries.

Patients with this condition experience muscle ache and 
fatigue after walking a certain distance.

It can be lifestyle-limiting, but evidence shows that the vast majority of symptoms will improve with medical management and patients will not require surgery.

This includes putting patients on aspirin and a statin to lower cholesterol, encouraging regular walking exercise and advice to stop smoking.

The surgical adage, “stop smoking and keep walking”, still holds true.

These are simple measures, which can be instituted by GPs and do not require a consultation with a specialist vascular surgeon.

Surgical intervention is not without risk and should be reserved for patients who still have significant symptoms despite a trial of other methods.

Patients who have severe symptoms of pain or ulceration fall into a different category and would always be seen on an 
urgent basis irrespective of their smoking status.

This strategy makes the best use of available resources and ensures that the right treatment is provided to all vascular
patients at the right time.

(Mr) Dan Ablett

Senior Surgical Registrar

(Mr) Zahid Raza

Clinical Director

Department of Vascular Surgery

Royal Infirmary of