title: The perioperative outcomes of eversion carotid endarterectomy in diabetic patients aged 80 years or older.
abstract: BACKGROUND
  Uncertainty exists about the influence of advanced age and diabetes mellitus on the clinical effect of carotid endarterectomy (CEA). This study analyzed the perioperative (30-day) outcomes of CEA in diabetic patients aged ≥80 years.
  
  
  METHODS
  Data of 1872 consecutive patients who underwent 2125 primary eversion CEAs from 1990 to 2014 at our institution were prospectively stored in a vascular surgery registry. Risk factors, medication, and indication for surgery were recorded. The 354 patients (387 CEAs) aged ≥80 years formed the study base; of whom, 207 (219 CEAs) were diabetic and 147 (168 CEAs) were not. A neurologist assessed all patients preoperatively, on waking from the anesthesia, and before discharge from the hospital. All procedures were eversion CEA performed by the same surgeon under general anesthesia with routine electroencephalographic monitoring for selective shunting.
  
  
  RESULTS
  Diabetic patients were more likely to have arterial hypertension (P = .033), cardiac disease (P = .038), peripheral aneurysmal/atherosclerotic disease (P = .046), and contralateral carotid occlusion (P = .042) than their nondiabetic counterparts. Overall, there were no deaths, two (0.51%) perioperative strokes (both in diabetic patients), and 13 nonfatal cardiac complications (3.3%), of which 10 occurred in diabetic patients, but the difference failed to reach statistical significance.
  
  
  CONCLUSIONS
  Findings from this study show that CEA is safe and effective for stroke prevention in diabetic patients aged ≥80 years, with a negligible incidence of perioperative adverse events and no deaths.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, Vascular Study Group, 3rd Surgical Clinic, University of Padua, School of Medicine, Padova, Italy. Electronic address: enzo.ballotta@unipd.it.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, Vascular Study Group, 3rd Surgical Clinic, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
authors.affiliation: Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Farina
authors.affiliation: Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000768:Anesthesia, General; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015897:Comorbidity; D048909:Diabetes Complications / Q000209:etiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods; D008297:Male; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome