Background
Few studies have focused directly on carotid endarterectomy (CEA) in symptomatic and
asymptomatic diabetic patients, reporting controversial outcome. We compared perioperative
(30-day) and late outcomes in diabetic versus nondiabetic patients undergoing CEA
for severe asymptomatic carotid disease.
Methods
Over 10 years, data were prospectively collected for diabetic and nondiabetic patients
undergoing CEA for asymptomatic severe carotid disease. All procedures were eversion
CEA. All patients underwent concomitant neurologic follow-up and a duplex ultrasound
scan at 1, 6, and 12 months, then yearly, after operation.
Results
Of 391 CEAs performed on 374 patients, 112 (28.7%) were in diabetic patients. There
were no perioperative deaths or strokes in either diabetic patients or nondiabetic
patients. A significantly higher incidence of cardiac complications occurred in diabetic
patients (P < .01). A complete follow-up (mean, 6.1 years) was obtained for 348 patients. No
recurrent stenoses or late occlusions were diagnosed in diabetic or nondiabetic patients.
At 10 years, the risk of death was up to 4.6 times higher in diabetic patients, with
a significant prevalence of cardiac-related deaths (P < .01).
Conclusions
CEA can be performed with no perioperative stroke risk or mortality, for asymptomatic
disease in both diabetic and nondiabetic patients. The absence of fatal strokes associated
with a significantly higher risk of cardiac-related death in the long-term points
to the need to improve prevention strategies for postoperative cardiac risk in diabetic
patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diabetes and atherosclerosis: epidemiology, pathophysiology, and management.JAMA. 2002; 287: 2570-2578
- Mortality by cause for eight regions of the world: Global Burden of Disease Study.Lancet. 1997; 349: 1269-1276
- Carotid plaque, aging and risk factors. A study of 457 patients.Stroke. 1994; 25: 1133-1140
- Diabetes and cardiovascular disease: the Framingham Study.JAMA. 1979; 241: 2035-2038
- The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study.Circulation. 1987; 75: 65-73
- The final results of the NASCET trial.N Engl J Med. 1998; 339: 1415-1425
- Randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).Lancet. 1998; 351: 1379-1387
- Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis.JAMA. 1995; 6273: 1421-1428
- Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial.Lancet. 2004; 363: 1491-1502
- Early cerebral complications in carotid endarterectomy: risk factors.J Cardiovasc Surg (Torino). 1990; 31: 162-167
- Diabetes mellitus: a risk factor for carotid endarterectomy?.J Vasc Surg. 1997; 25: 1070-1076
Ahari A; the SWEDVASC. Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy: a population-based study. Eur J Vasc Endovasc Surg 199;18:122-6.
- Is diabetes mellitus a risk factor for carotid endarterectomy? A prospective study.Surgery. 2001; 129: 146-152
- Carotid endarterectomy in diabetic patients.J Vasc Surg. 2001; 33: 148-154
- Risk factors for complications after carotid endarterectomy: a population based study.Eur J Vasc Endovasc Surg. 2004; 28: 98-103
- The safety of carotid endarterectomy in diabetic patients: clinical predictors of adverse outcome.J Vasc Surg. 2005; 42: 878-883
- Selective shunting with eversion carotid endarterectomy.J Vasc Surg. 2003; 38: 1045-1050
- Suggested standards for reports dealing with cerebrovascular disease.J Vasc Surg. 1988; 8: 721-729
- Outcomes of carotid endarterectomy for asymptomatic stenosis in Sweden are improving: results from a population-based study.J Vasc Surg. 2006; 44: 79-85
- Analysis of the effect of asymptomatic carotid atherosclerosis study on the outcome and volume of carotid endarterectomy.Cardiovasc Surg. 2000; 8: 436-440
- Carotid endarterectomy by eversion technique: its safety and durability.Ann Surg. 1998; 228: 471-478
- Single center experience on eversion versus standard carotid endarterectomy: a prospective non-randomized study.Cardiovasc Surg. 2000; 8: 422-428
- Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial.J Vasc Surg. 2000; 31: 19-30
- Durability of carotid endarterectomy for treatment of symptomatic and asymptomatic stenoses.J Vasc Surg. 2004; 40: 270-278
Kahn CR; for the Diabetes Research Working Group. Conquering diabetes: a strategic plan for the 21st century. A report of the congressionally-established Diabetes Research Working Group, 1999, p. 84. Available: www.niddk.nih.gov/federal/dwg/fr.pdf. Accessed March 8, 2007.
- Lack of association of diabetes with increased postoperative mortality and cardiac morbidity.Arch Surg. 2002; 137: 417-421
- Carotid endarterectomy at the millennium: What interventional therapy must match.Ann Surg. 2004; 240: 535-546
- Long-term survival after carotid endarterectomy for asymptomatic stenosis.Stroke. 2006; 37: 2886-2891
Article info
Publication history
Published online: January 03, 2008
Accepted:
October 17,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
