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The drastic change in global climate has led to in-depth studies of the geneticresources of native cattle adapted to challenging environments. Native cattle breeds may harbor unique genetic mechanisms that have enabled them adapt to their given environmental conditions. Adipose tissues are key factors in the regulation of metabolism and energy balance and are crucial for the molecular switches needed to adapt to rapid environmental and nutritional changes. The transcriptome landscape of four adipose tissues was used in this study to investigate the differential gene expression profiles in three local breeds, Yakutian cattle (Sakha Republic), Northern Finncattle (Finland), Mirandesa cattle (Portugal) and commercial Holstein cattle. A total of 26 animals (12 cows, 14 bulls) yielded 81 samples of perirenal adipose tissue (n = 26), metacarpal adipose tissue (n = 26), tailhead adipose tissue (n = 26) and prescapular adipose tissue (n = 3). More than 17,000 genes were expressed in our dataset. Principal component analysis of the normalized expression profiles revealed a differential expression profile of the metacarpal adipose tissue. We found that the genes upregulated in the metacarpal adipose tissue of Yakutian cattle, such as NR4A3, TEKT3, and FGGY, were associated with energy metabolism and response to cold temperatures. In Mirandesa cattle, the upregulated genes in perirenal adipose tissue were related to immune response and inflammation (AVPR2, CCN1, and IL6), while in Northern Finncattle, the upregulated genes appeared to be involved in various physiological processes, including energy metabolism (IGFBP2). According to the sex-based comparisons, the most interesting result was the upregulation of the TPRG1 gene in three tissues of Yakutian cattle females, suggesting that adaptation is related to feed efficiency. The highest number of differentially expressed genes was found between Yakutian cattle and Holstein, several of which were associated with immunity in Yakutian cattle, indicating potential differences in disease resistance and immunity between the two breeds. This study highlights the vast difference in gene expression profiles in adipose tissues among breeds from different climatic environments, most likely highlighting selective pressure and the potential significance of the uniquely important regulatory functions of metacarpal adipose tissue., (© 2024. The Author(s).)

Reindeer, called caribou in North America, has a circumpolar distribution and all extant populations belong to the same species ( Rangifer tarandus ). It has survived the Holocene thanks to its immense adaptability and successful coexistence with humans in different forms of hunting and herding cultures. Here, we examine the paternal and maternal history of Rangifer based on robust Y-chromosomal and mitochondrial DNA (mtDNA) trees representing Eurasian tundra reindeer, Finnish forest reindeer, Svalbard reindeer, Alaska tundra caribou, and woodland caribou. We first assembled Y-chromosomal contigs, representing 1.3 Mb of single-copy Y regions. Based on 545 Y-chromosomal and 458 mtDNA SNPs defined in 55 males, maximum parsimony trees were created. We observed two well separated clades in both phylogenies: the "EuroBeringian clade" formed by animals from Arctic Islands, Eurasia, and a few from North America and the "North American clade" formed only by caribou from North America. The time calibrated Y tree revealed an expansion and dispersal of lineages across continents after the Last Glacial Maximum. We show for the first time unique paternal lineages in Svalbard reindeer and Finnish forest reindeer and reveal a circumscribed Y haplogroup in Fennoscandian tundra reindeer. The Y chromosome in domesticated reindeer is markedly diverse indicating that several male lineages have undergone domestication and less intensive selection on males. This study places R. tarandus onto the list of species with resolved Y and mtDNA phylogenies and builds the basis for studies of the distribution and origin of paternal and maternal lineages in the future., Competing Interests: The authors declare no competing interest., (© 2024 The Author(s). Ecology and Evolution published by John Wiley & Sons Ltd.)

Introduction: Spontaneous arteriovenous fistulas (AVF), in contrast to iatrogenic or post-traumatic ones, are extremely rare and only sporadically published in the literature. In the absence of exposure risk, the diagnosis of AVF can be challenging, especially if it is an incidental finding., Case History: An 80-year-old female patient presented to our vascular consultation because of swelling of the left leg due to varicosis. For years, she had also noticed that the right foot seemed to be cooler. Percutaneous catheter examinations via the groin had not been performed, and she could not remember any groin injuries., Examination and Findings: Truncal varicosis of the great saphenous vein confirmed clinically and sonographically. In addition, with peripheral pulses obtained, the right foot appeared slightly cooler but not discolored. On auscultation, a systolic-diastolic murmur accompanied by palpable buzzing was heard in the right groin. Color duplex sonography showed a coarse color mosaic pattern between the common femoral artery (AFC) and the anterior saphenous vein (VSAA) in the sense of aliasing ("confetti phenomenon"). A fistula channel between the AFC and VSAA could be visualized, in which very high systolic-diastolic flow velocities prevailed; pulsatile and turbulent flow was present in the region of the crosse-near femoral vein., Therapy and Course: Endovenous laser ablation was performed for symptomatic truncal varicosis of the left leg. Under ultrasound-guided compression of the afferent artery and fistula at the right groin, the fistula flow did not stop. The patient was reluctant to undergo a proposed interventional closure of the AVF. In follow-up over 4 years, no signs of cardiac insufficiency or critical limb ischemia developed., Discussion: Spontaneous femoral AVF is a rarity. Characteristic clinical findings lead to a targeted use of color duplex sonography with correct interpretation of artifacts that can otherwise be easily missed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Domestic reindeer (Rangifer tarandus) play a vital role in the culture and livelihoods of indigenous people across northern Eurasia. These animals are well adapted to harsh environmental conditions, such as extreme cold, limited feed availability and long migration distances. Therefore, understanding the genomics of reindeer is crucial for improving their management, conservation and utilisation. In this study, we have generated a new genome assembly for the Fennoscandian domestic reindeer with high contiguity, making it the most complete reference genome for reindeer to date. The new genome assembly was utilised to explore genetic diversity, population structure and selective sweeps in Eurasian Rangifer tarandus populations which was based on the largest population genomic dataset for reindeer, encompassing 58 individuals from diverse populations. Phylogenetic analyses revealed distinct genetic clusters, with the Finnish wild forest reindeer (Rangifer tarandus fennicus) standing out as a unique subspecies. Divergence time estimates suggested a separation of ~ 52 thousand years ago (Kya) between the northern European Rangifer tarandus fennicus and Rangifer tarandus tarandus. Our study identified four main genetic clusters: Fennoscandian, the eastern/northern Russian and Alaskan group, the Finnish forest reindeer, and the Svalbard reindeer. Furthermore, two independent reindeer domestication processes were inferred, suggesting separate origins for the domestic Fennoscandian and eastern/northern Russian reindeer. Notably, shared genes under selection, including retroviral genes, point towards molecular domestication processes that aided adaptation of this species to diverse environments., (© 2023. The Author(s).)

Introduction: Cystic adventitial degeneration (CAD) is a rare vascular disease, affects mostly middle-aged men, and as a nonatherosclerotic disease, is an uncommon differential diagnosis of intermittent claudication., Case History: A 56-year-old female patient presented to our medical office because of unexplained right-sided calf pain that was not constantly load-dependent. The complaints fluctuated considerably with longer symptom-free intervals., Examination and Findings: Clinically, the patient presented regular pulses, which were maintained even with provocative maneuvers such as plantar flexion and knee flexion. Duplex sonography showed cystic masses around the popliteal artery. On MRI examination, a tubular tortuous connection to the knee joint capsule also appeared to be visualizable. A diagnosis of cystic adventitial degeneration was made., Therapy and Course: In the absence of constant impairment of walking performance with symptom-free intervals as well as morphological and functional signs of stenosis, interventional or surgical therapy was not desired by the patient. Short-term follow-up revealed stable clinical and sonomorphologic findings over an observation period of 6 months so far., Discussion: CAD should also be considered in female patients with atypical leg symptoms. There are no uniform treatment recommendations for CAD, which is why it is a challenge to select the optimal, usually interventional procedure. In patients with few symptoms and no critical ischemia, a conservative approach with close follow-up may be justified, as in our case report., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Reindeer (Rangifer tarandus) are semi-domesticated animals adapted to the challenging conditions of northern Eurasia. Adipose tissues play a crucial role in northern animals by altering gene expression in their tissues to regulate energy homoeostasis and thermogenic activity. Here, we perform transcriptome profiling by RNA sequencing of adipose tissues from three different anatomical depots: metacarpal (bone marrow), perirenal, and prescapular fat in Finnish and Even reindeer (in Sakha) during spring and winter. A total of 16,212 genes are expressed in our data. Gene expression profiles in metacarpal tissue are distinct from perirenal and prescapular adipose tissues. Notably, metacarpal adipose tissue appears to have a significant role in the regulation of the energy metabolism of reindeer in spring when their nutritional condition is poor after winter. During spring, genes associated with the immune system are upregulated in the perirenal and prescapular adipose tissue. Blood and tissue parameters reflecting general physiological and metabolic status show less seasonal variation in Even reindeer than in Finnish reindeer. This study identifies candidate genes potentially involved in immune response, fat deposition, and energy metabolism and provides new information on the mechanisms by which reindeer adapt to harsh arctic conditions., (© 2021. The Author(s).)

Temperature is increasing in Arctic and sub-Arctic regions at a higher rate than anywhere else in the world. The frequency and nature of precipitation events are also predicted to change in the future. These changes in climate are expected, together with increasing human pressures, to have significant impacts on Arctic and sub-Arctic species and ecosystems. Due to the key role that reindeer play in those ecosystems, it is essential to understand how climate will affect the region's most important species. Our study assesses the role of climate on the dynamics of fourteen Eurasian reindeer (Rangifer tarandus) populations, using for the first time data on reindeer abundance collected over a 70-year period, including both wild and semi-domesticated reindeer, and covering more than half of the species' total range. We analyzed trends in population dynamics, investigated synchrony among population growth rates, and assessed the effects of climate on population growth rates. Trends in the population dynamics were remarkably heterogeneous. Synchrony was apparent only among some populations and was not correlated with distance among population ranges. Proxies of climate variability mostly failed to explain population growth rates and synchrony. For both wild and semi-domesticated populations, local weather, biotic pressures, loss of habitat and human disturbances appear to have been more important drivers of reindeer population dynamics than climate. In semi-domesticated populations, management strategies may have masked the effects of climate. Conservation efforts should aim to mitigate human disturbances, which could exacerbate the potentially negative effects of climate change on reindeer populations in the future. Special protection and support should be granted to those semi-domesticated populations that suffered the most because of the collapse of the Soviet Union, in order to protect the livelihood of indigenous peoples that depend on the species, and the multi-faceted role that reindeer exert in Arctic ecosystems.

Snow conditions play an important role for reindeer herding. In particular, the formation of ice crusts after rain-on-snow (ROS) events or general surface thawing with subsequent refreezing impedes foraging. Such events can be monitored using satellite data. A monitoring scheme has been developed for observation at the circumpolar scale based on data from the active microwave sensor SeaWinds on QuikSCAT (Ku-band), which is sensitive to changes on the snow surface. Ground observations on Yamal Peninsula were used for algorithm development. Snow refreezing patterns are presented for northern Eurasia above 60 degrees N from autumn 2001 to spring 2008. Western Siberia is more affected than Central and Eastern Siberia in accordance with climate data, and most events occur in November and April. Ice layers in late winter have an especially negative effect on reindeer as they are already weakened. Yamal Peninsula is located within a transition zone between high and low frequency of events. Refreezing was observed more than once a winter across the entire peninsula during recent years. The southern part experienced refreezing events on average four times each winter. Currently, herders can migrate laterally or north-south, depending on where and when a given event occurs. However, formation of ice crusts in the northern part of the peninsula may become as common as they are now in the southern part. Such a development would further constrain the possibility to migrate on the peninsula.

Tundra ecosystems are vulnerable to hydrocarbon development, in part because small-scale, low-intensity disturbances can affect vegetation, permafrost soils, and wildlife out of proportion to their spatial extent. Scaling up to include human residents, tightly integrated arctic social-ecological systems (SESs) are believed similarly susceptible to industrial impacts and climate change. In contrast to northern Alaska and Canada, most terrestrial and aquatic components of West Siberian oil and gas fields are seasonally exploited by migratory herders, hunters, fishers, and domesticated reindeer (Rangifer tarandus L.). Despite anthropogenic fragmentation and transformation of a large proportion of the environment, recent socioeconomic upheaval, and pronounced climate warming, we find the Yamal-Nenets SES highly resilient according to a few key measures. We detail the remarkable extent to which the system has successfully reorganized in response to recent shocks and evaluate the limits of the system's capacity to respond. Our analytical approach combines quantitative methods with participant observation to understand the overall effects of rapid land use and climate change at the level of the entire Yamal system, detect thresholds crossed using surrogates, and identify potential traps. Institutional constraints and drivers were as important as the documented ecological changes. Particularly crucial to success is the unfettered movement of people and animals in space and time, which allows them to alternately avoid or exploit a wide range of natural and anthropogenic habitats. However, expansion of infrastructure, concomitant terrestrial and freshwater ecosystem degradation, climate change, and a massive influx of workers underway present a looming threat to future resilience.

Background: Colour Doppler sonography (CDS) is an established technique in the diagnosis of giant-cell (temporal) arteritis (GCA). The predictive value of its diagnostic criteria for GCA (halo sign or stenosis) is related to the pretest probability (PTP), a measure of probability of presence of a target disease before the result of a diagnostic test is known., Patients and Methods: A total of 182 (average age 69 years, 69% women) patients of the Rheumatology Center Baden-Württemberg were investigated. Based on the diagnostic criteria of the American College of Rheumatology (ACR) they were assigned to one of three groups, before a CDS was performed: group 1 (n= 139) patients with "isolated" polymyalgia rheumatica (PMR) and a low PTP for GCA; group 2 (n=19) patients with intermediate PTP and nonspecific headache and fewer than three ACR criteria for GCA); and group 3 (n=224) patients with a high PTP and new headache loclized to the temporal artery and at least three ACR criteria for GCA., Results: The halo sign (periluminal dark halo) of more than 0.3 mm was present in 26% of group 1. 42% of those in group 2 and 83% of those in group 3. A stenosis or occlusion of the temporal artery was present in 3.5% (group 1), 5% (group 2) and 46% (group 3), respectively. 3 of 24 patients of group 3 also had a stenosis of the axillary or brachial artery. Concordance between clinical criteria and CDS (normal CDS in patients with PMR but no headache or abnormal CDS and clinically suspected BCA was found in 123 of 182 patients (67.5%). In these patients biopsy of the temporal artery ("gold standard" for the diagnosis of GCA) was not recommended. Temporal artery biopsy was, however, recommended in all patients with discordant findings (abnormal CDS with PMR but no headache or normal CDS with clinically suspected GCA, and also those with intermediary PTP (32%). A biopsy was performed in 42 of these patients after informed consent had been obtained. This demonstrated vasculitis in 11 of 25 patients with PMR (PPV in group 1: 0.44). But biopsies were negative in all four patients with clinically suspected GCA and normal CDS (NPV in group 3:1). In the intermediary group biopsy demonstrated vasculitits in 5 of 6 patients with an abnormal CDS (PPV 0.63), while 4 of 5 patients with a normal CDS had a normal biopsy (NPV 0.8)., Conclusion: Taking into account pretest probability, an RCA can be accurately diagnosed or excluded by CDS in two thirds of patients without biopsy. When performed by an experienced investigator CDS is a basic part in the diagnosis of CDA., (Copyright Georg Thieme Verlag KG Stuttgart . New York.)

History: A 63-year-old man, known to have Bechterev's disease was admitted because of weight gain and nocturnal sweating. He also had signs of heart failure with progressive exertional dyspnoea. Many months previously numerous bleedings had occurred in the skin, predominantly the face (periorbital and perioral), the inguinal region and the penis., Investigations: Extensive diagnostic test failed to find any evidence of tumor. The Rumpel-Leede tourniquet test was positive, while platelet functions was normal, suggesting vascular disease. The skin biopsy showed many perivascular amyloid deposits (AL). Immunochemical differentiation also demonstrated the same amyloid in rectal and hepatic biopsies. But there was AA amyloid in a hepatic artery. Immunophoresis indicated a biclonal gammopahty of unknown significance., Diagnosis, Treatment and Course: These findings indicated the diagnosis of primary AL amyloidosis associated with a gammopathy of unknown significance and a secondary AA amyloidosis in the presence of chronic Bechterev s disease. The clinical picture also showed cardiac complications, predominantly heart failure and numerous previous myocardial infarctions without S-T elevations. Echocardiography, which revealed marked thickening of the left ventricle with a restrictive filling pattern, suggested cardiac co-morbidity. The patient underwent chemotherapy with melphalan and prednisone but had a sudden cardiac death., Conclusion: In a case of bleeding of unknown cause systemic amyloidosis should be considered in the differential diagnosis. A tendency towards bleeding, as in this patient, may be the first sign of amyloidosis, which ist often diagnosed quite late in the course of the disease.

Early diagnosis and treatment of deep venous thrombosis (DVT) in the leg is of decisive importance, in particular in view of the potentially life-threatening complication of pulmonary embolism. The establishment of the diagnosis if often difficult since in the early stage symptoms may be non-existent or few (50%). The most important therapeutic measure is compression. Acute medication is initiated within the first 24 hours with unfractionated conventional heparin administered as a continuous i.v. infusion or intermittent s.c. injections. An initial bolus injection is followed by continuous infusion of 30,000-40,000 units of heparin. More recent data show that low-molecular-weight heparins are as effective as conventional heparin and are easier to apply, making acute treatment on an ambulatory basis feasible. Conversion to anticoagulation treatment is effected with gradually increasing doses, and must overlap heparin for at least 4-5 days. The duration of treatment is determined by the nature of the thrombosis, with recommendations ranging from 3 to 12 months. A shortened in-hospital treatment with early mobilization is considered to be of benefit to the patient.

History and Admission Findings: A 57-year-old woman, a heavy smoker and migraine sufferer, was admitted with severe resting pain in the right forefoot and painful localized tendril-shaped reddening on the right thigh. She had regularly been taking 1-2 mg ergotamine tartrate, several analgesics, some containing caffeine, and selective serotonin-uptake inhibitors. Clinical examination found all limbs to be cool. On the right leg the pulse was not palpable below the inguinal line, and the reddening corresponded to localized livedo., Investigations: The peripheral Doppler pressure indicated critical perfusion reduction in the right leg with a tibiobrachial pressure ratio of 0.14. Colour-coded duplex sonography showed generalized vasoconstriction with filiform hourglass stenosis of the right proximal superficial femoral artery without atherosclerotic changes. The history of drug intake and the characteristic sonographic findings indicated ergotism and an arteriography was deemed unnecessary., Treatment and Course: All ergotamine and caffeine containing drugs were discontinued and the patient urged to stop smoking. Amlidopine, 2.5 mg orally, and prostaglandin E1, 60 microgram i.v., were administered daily. The resting pain was much reduced after the first infusion and the painful livedo disappeared. The documented high-grade stenosis of the right superficial femoral artery was reduced to 25-50% by the third day of infusion. At the end of 10 daily infusions both the Doppler pressure and the duplex sonography had become normal. Pizotifen was given for the migraine and the serotonin re-uptake inhibitor sertralin was discontinued., Conclusion: An interaction of the serotonin re-uptake inhibitor with ergotamine was presumably responsible for the development of ergotism under >>therapeutic<< ergotamine dosage. Vasospastic stenoses and occlusions can be demonstrated by duplex sonography and may in future not require additional angiographic confirmation. Intravenous rather than intraarterial infusion of prostaglandin is to be preferred if vessels at many sites are affected. Livedo is a transitory sign of ergotism.

Background and Objective: Recent studies have described characteristic sonographic signs in patients with manifest temporal arteritis (TA). It was the aim of this study to determine whether sonography can identify TA without clinical signs but biopsy evidence of giant-cell arteritis in patients with rheumatic polymyalgia (RP)., Patients and Methods: 22 patients (14 women, 8 men; average age 67.4 +/- 9.1 years) with RP but no clinical signs of TA were prospectively examined for TA by colour-coded duplex sonography (ATL HDI 3000, linear 12-5 Mhz) before temporal artery biopsy was taken. If there was clinical suspicion of extratemporal involvement, other vessels were also examined selectively. The biopsy was taken from a site identified by the sonography. A definitive diagnosis of TA was made only if there was a positive biopsy., Results: In seven of the 22 patients (32%) sonography showed an echo-poor halo around the lumen of the temporal artery. Five of these seven patients also had histological evidence of giant-cell arteritis. Conversely, all of the five patients had abnormal sonographic findings, namely a marked halo with a minimal thickness of 0.7 mm. Two of the five patients also had temporal artery stenosis, i.e. there was a 100% sensitivity and 80% specificity with respect to the halo sign in conformance with the histology. Two patients with TA were also shown sonographically to have stenosis in arteries of the shoulder girdle and arm. Stenoses in the renal and mesenteric arteries as well of the coeliac trunk were demonstrated in one patient., Conclusions: Colour-coded sonography with a high-frequency transducer head probably provides reliable diagnosis of TA in patients with RP, even in the absence of clinical signs of vascular inflammation. It remains to be proven whether sonography without biopsy is reliable enough for the diagnosis and treatment of asymptomatic TA.

Purpose: The necessity of effective prevention of DVT is generally accepted. However, attitudes and beliefs concerning prophylaxis vary greatly in terms of the risk groups receiving prophylaxis and the prophylactic methodology. This paper reviews current research on the subject and seeks to provide recommendations., Results: Known clinical risk factors allow the classification of patients according to high, medium and low risk of developing thromboembolism. Basic forms of prophylaxis are physiotherapy and early mobilisation. However, there are no data on the safety and efficacy of these methods. Mechanical devices used include external intermittent pneumatic compression and graduated compression stockings. Used in isolation, these methods reduce the incidence of deep vein thrombosis in low and moderate risk patients by one half or one third. There is no distinction between mechanical and pharmacological methods in terms of safety and efficacy. Furthermore, secondary effects are extremely rare. Moderate and high risk category patients should receive combined modes of mechanical and pharmacological treatment. A direct comparison of safety in moderate risk patients fixed doses of standard heparin vs. low molecular weight heparin revealed no significant differences. In the case of high risk patients, adjusted dose heparin administered subcutaneously or fixed dose low molecular heparin is recommended. A severe secondary effect of heparin-prophylaxis is heparin-induced thrombocytopenie. The optimum duration of pharmacological prophylaxis is not yet clear., Conclusion: The methods and duration of prophylaxis remain subject to an individual medical assessment of the clinically significant benefits in relation to the risk secondary effects of the treatment. On major questions there are significant variations in the specialist literature. This means that standards cannot be formulated, although recommendations can be given.

Objective: As hyperhomocysteinaemia is known to be an important risk factor in the early onset of arteriosclerotic occlusive disease and leg-vein thrombosis, we investigated the prevalence of hyperhomocysteinaemia in patients with thromboangiitis obliterans (TAO), a condition predominantly affecting peripheral arteries and veins., Patients and Methods: Plasma homocysteine (HC), before and after administration of methionine (0.1 g/kg) as well as serum folic acid, vitamins B6 and B12 were measured in 15 patients with TAO (12 men, 3 women; mean age 33.3 years: group 1), in 15 non-smokers without peripheral vascular disease (group 2) and 15 smokers without peripheral vascular disease (group 3). At the time of the study, of those in group 1 seven were active smokers, seven were ex-smokers and one was a non-smoker., Results: Before methionine administration four patients (27%), none of the healthy non-smokers and one smoker without vascular disease (7%) had increased HC levels (> 13.9 nmol/ml). The difference between groups 1 and 2 was statistically significant (P < 0.05), but not that between groups 1 and 3 and between 2 and 3. 4 hours after methionine increased HC levels (> or = 31 nmol/ml) were measured in nine patients but in none of the healthy controls. The difference between patients and the two control groups without vascular disease was clearly significant (P = 0.0107). There was a difference in folic acid levels between the patients and the smokers without vascular disease: in eight patients (53%) the levels were in the lower third of normal, in six (40%) they were in the middle and in one (7%) in the upper third. Corresponding levels in group 3 were: four (27%), three (20%) and eight (53%)., Conclusion: Hyperhomocysteinaemia occurs frequently in patients with TAO. It may play an important and nicotine-independent role in its pathogenesis.

Smoking is a major risk factor for peripheral arterial occlusive disease (PAOD) and plays a crucial role in the pathogenesis of the thrombangiitis obliterans (TAO), nicotine and carboxyhemoglobin cause functional disturbances and structural damage of the endothelial cells which may initiate arteriosclerosis. Additional effects of smoking are hyperfibrinogenemia, lowering of HDL-cholesterol and increased oxidation of LDL-cholesterol. By these mechanisms, smoking influences other primary risk factors for arteriosclerosis. Patients with PAOD, who continue to smoke, have a worse clinical prognoses with higher amputation and mortality rates than those who quit smoking. The most urgent goal in the therapy of PAOD and TAO should be an immediate and complete smoking cessation. However most patients continue to smoke despite the knowledge of the hazards to their health. An appropriate approach to this addiction may be an alternative application of nicotine temporarily (transdermal by patches or chewing gum) and behavioral treatment. This combined therapy results in better success rates in terms of smoking cessation.