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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Accepted: January 25, 2008
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.