In this issue of SURGERY, Ballotta and coauthors report 10-year follow-up of a large series of asymptomatic
diabetic patients treated with carotid endarterectomy. It has been repetitively demonstrated
that when it comes to surgery, diabetes has a significant impact on outcome; this
is particularly true for diabetic patients with vascular disease. For example, diabetic
patients with lower extremity vascular disease have a disease pattern that is difficult
to treat; patients are prone to amputation and have limited survival compared to patients
without diabetes. Moreover, the decision to intervene for vascular disease and the
type of intervention will change with the predicted longevity of the patient. It is
imperative that practitioners recognize the impact of diabetes on early outcomes as
well as on longevity so that that treatment decisions can be individualized for the
diabetic population. Ballotta and coauthors in this article use their large experience
with carotid endarterectomy (CEA) to ask whether diabetic patients with asymptomatic
carotid artery disease benefit initially and over the long term, from intervention.
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References
- Carotid endarterectomy at the millennium: what interventional therapy must match.Ann Surg. 2004; 240: 535-546
- Endarterectomy for asymptomatic carotid artery stenosis.JAMA. 1995; 6273: 1421-1428
- Prevention of fatal and disabling strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial.Lancet. 2004; 363: 1491-1502
Article info
Publication history
Accepted:
January 25,
2008
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
