Key result
Persistent tobacco use driven by severe nicotine dependence led to worsening limb ischemia and the need for definitive surgical intervention despite repeated counseling.
Why the study?
Nicotine dependence promotes peripheral arterial disease progression and undermines adherence to lifestyle modification, but psychiatric interventions remain underutilized in such patients.
Case Report (n=1)
No
This case highlights the critical need to integrate psychiatric care, such as motivational interviewing and pharmacotherapy, into the management of patients with peripheral arterial disease and severe nicotine dependence to improve adherence and outcomes.
Case of refractory nicotine dependence in advanced PAD illustrates adherence barriers; leaves open whether psychiatric integration improves limb salvage.
Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis strongly linked to tobacco use. Nicotine dependence contributes not only to disease progression but also to poor adherence to treatment and lifestyle modification. We report a 56-year-old male with advanced PAD and long-standing nicotine dependence who continued smoking despite repeated counseling and the impending risk of limb loss. Psychiatric evaluation revealed severe nicotine dependence with low motivation to quit and behavioral resistance. This case illustrates the bidirectional relationship between substance use and chronic medical illness. Persistent tobacco use worsens vascular outcomes, while dependence-related behaviors undermine adherence to medical advice. Evidence-based psychiatric interventions such as motivational interviewing and pharmacotherapy remain underutilized in such cases. Integrating psychiatric care into vascular management is crucial for improving outcomes in PAD patients with nicotine dependence.
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Pai et al. (2026) conducted a case report in Peripheral arterial disease and nicotine dependence (n=1). Continued tobacco smoking (Nicotine dependence) was evaluated on Disease progression (worsening ischemia and need for surgical intervention). Persistent tobacco use driven by severe nicotine dependence led to worsening limb ischemia and the need for definitive surgical intervention despite repeated counseling.
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