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The "Image of the Month" in the January 2003 issue of the ARCHIVES nicely depicts fibromuscular dysplasia of the internal carotid artery.¹ However, I disagree with the recommendation for graduated dilatation of the internal carotid artery. The patient was 72 years old and, more importantly, asymptomatic. Fibromuscular dysplasia may cause flowrelated symptoms, and, if this problem develops, then dilatation could be performed.² The recommendation to perform surgery on an asymptomatic 72-year-old with at worst a very slowly progressive disorder is too drastic a solution.

James F. Upson, MD
Orchard Park, NY

1. Bush RL, Bianco CC. Image of the month. Arch Surg. 2003;138:109-110. FREE FULL TEXT 2. Upson JF, Raza ST. Fibromuscular dysplasia of internal carotid arteries: graduated internal dilatation by arterial Fogarty catheter. N Y State J Med. 1976;76:972-974. PUBMED

Arch Surg. 2003;138:928.