The Impact of Cannabis Use on the Prevalence, Progression and Development of Lower Limb Peripheral Arterial Disease: A Narrative Review

BACKGROUND: The recent legalisation of cannabis for recreational use in several Australian states, alongside similar global trends, has heightened interest in its potential vascular health implications. While the psychoactive and neurological effects of cannabis are well characterised, its role in the pathogenesis of peripheral arterial disease (PAD) remains poorly defined. Emerging evidence suggests that cannabis may contribute to acute limb ischaemia (ALI) and chronic limb threatening ischaemia (CLTI) through distinct vascular mechanisms. METHODS: A narrative review of the literature was undertaken, incorporating epidemiological data, clinical studies and mechanistic investigations. Particular emphasis was placed on pathophysiological processes relevant to arterial compromise and their association with cannabis use disorder (CUD). Evidence was synthesised to highlight epidemiological trends and surgical management considerations. RESULTS: Several mechanisms have been proposed to explain cannabis-associated vascular risk, including cannabinoid-induced vasospasm, endothelial dysfunction, platelet aggregation and oxidative stress. Lifestyle factors and comorbidities frequently observed among cannabis users may further potentiate these processes. Epidemiological studies demonstrate associations between CUD and increased incidence of PAD-related complications, particularly ALI and CLTI. Limited clinical data also suggest potential adverse perioperative outcomes, though findings are inconsistent and often confounded by concurrent substance use. CONCLUSION: Cannabis use may represent an under-recognised risk factor for PAD and related vascular complications. With legalisation expanding in Australia and internationally, clinicians should maintain vigilance, particularly in younger patients presenting with lower limb ischaemia. Further prospective research is required to delineate causal mechanisms, quantify risk and inform evidence-based management strategies.