Whether smokers should be offered bypass surgery remains controversial despite the extensive airing the topic had in the BMJ's columns last year.1 Nearly all patients requiring such operations have smoked for long periods.2 Are there any benefits of giving up at this late stage?

With non-invasive techniques and objective markers of smoking it has been shown that one year after peripheral arterial bypass surgery the patency of femoropopliteal vein grafts in continuing smokers (63%) is significantly less than the patency of grafts in those who no longer smoke (84%).3 The results of prosthetic distal bypass surgery are similar - the chance of graft failure is doubled in smokers.4 Surveillance of the patency of coronary artery bypass grafts is more difficult, requiring serial angiography, and no study that has used objective markers of smoking has been reported. Nevertheless, some studies have reported an association between smoking and an increased risk of failed coronary bypass grafts.^5,6 Continuing to smoke after surgery also has an adverse influence on the prognosis of aortofemoral bypass grafts.7

On …