AT PRESENT, rates of carotid endarterectomy (CE) are skyrocketing in the United States. A recent study found a 68% increase in the volume of CEs performed in Florida in the years 1995 and 1996, compared with the previous 3 years.¹In the most rapidly growing segment of the population, the elderly, the rate of increase (92%) was even more staggering. This increase in surgical volume was accompanied by a $56 million increase in health care expenditures, which occurred in 1 state in only 1 year. A similar increase in the volume of CEs (43.4%) was also noted in Veterans Affairs hospitals in the United States for fiscal year 1995.²