THE MICROANGIOPATHY that frequently causes death in individuals with juvenile diabetes mellitus is so well recognized and ingrained in our thinking that patients with maturity-onset diabetes are commonly assumed to have similar vascular abnormalities. This misconception is widely held by practicing physicians and is perpetuated in our medical schools, so that emerging physicians continue to believe that microangiopathy precludes vascular reconstruction of larger vessels in the patient with adult-onset diabetes.
Basement membrane thickening at the capillary level is associated with aging and, to a greater degree, with maturity-onset diabetes.1,2 This, however, is a segmental lesion that does not obstruct flow but may limit nutrient exchange across the capillary wall. Occlusive disease at the level of the small arteries and arterioles was not found to be more prevalent in adult diabetics than in nondiabetics by two careful studies.3,4
Combined with this anatomic evidence1-4 indicating lack of obliterative diabetic