World Journal of Cardiovascular Diseases, 2013, 3, 13-24 WJCD doi:10.4236/wjcd.201334A004 Published Online July 2013 (http://www.scirp.org/journal/wjcd/ ) Coronary artery bypass grafting in diabetic patients: Should we still use the saphenous vein graft? A review of literature in the past 15 years Alberto Molardi 1 , Filippo Benassi 1 , Francesco Nicolini 2 , Francesco Maestri 2 , Tiziano Gherli 2 1 Dipartimento Cardio-Nefro-Polmonare, UO Di Cardiochirurgia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy 2 Sezione di Cardiochirurgia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Parma, Parma, Italy Email: alberto.molardi@gmail.com Received 23 May 2013; revised 23 June 2013; accepted 5 July 2013 Copyright © 2013 Alberto Molardi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT The burden of diseases associated with diabetes mel- litus is dramatic: adults with diabetes mellitus are 2 to 4 times more likely to have cardiovascular diseases than those without it, and at least 65% will die be- cause of diabetes complications. The revasculariza- tion strategy in these types of patients included per- cutaneous coronary interventions with bare metal stents or medicated stents and surgical coronary ar- tery bypass grafting (CABG), but it is well known that in the diabetic patient with two or more vessel disease, the surgical strategy allows the best mid- and long- term results. Moreover, benefits of CABG surgery are limited by life expectancy of the most common type of graft, the saphenous vein (SV). Nearly 40 years after the introduction of bypass surgery, the rate of vein graft failure remains at high levels. Several arterial conduits had been studied as alternative conduits to SV: the Right Internal Thoracic Artery (RITA), the Radial Artery (RA), the Gastroepiploic Artery (GEA) and the Inferior Epigastric Artery (IEA), 40 years ago. The aim of our article is to review the scientific literature of the past 15 years to answer this question: are we ready to treat the diabetic patient, with a com- pletely arterial revascularization, avoiding the use of the great saphenous vein grafts? Keywords: Total Arterial Revascularization; Coronary Artery Bypass Grafting; Diabetes; Review 1. INTRODUCTION The burden of diseases associated with diabetes mellitus is dramatic: adults with diabetes mellitus are 2 to 4 times more likely to have cardiovascular diseases than those without it, and at least 65% will die because of diabetes complications [1]. The national burden of cardiovascular diseases caused by diabetes mellitus is increasing, at an unprecedented rate in all western countries [1,2]. Cardiovascular disease in diabetics is clinically chal- lenging because they tend to be extensive with multives- sel involvement [3,4]. It is why surgical revascularization has been reported to be well suited for diabetic patients [5,6]. Typically, the elderly are the patients waiting for coro- nary artery bypass grafting (CABG) surgery with diabe- tes mellitus. Female gender is increasing in the diabetic population. Diabetic patients often have a history of hy- pertension and myocardial infarction. Frequently, they have manifestations of congestive heart disease, resulting in NYHA classification III-IV. It has been shown that diabetic patients have a smaller vessel diameter [7], and statistically they have three-vessel disease more fre- quently and a lower left ventricular ejection fraction [8,9]. The revascularization strategy in these types of pa- tients included percutaneous coronary interventions with bare metal stents or medicated stents and surgical cor- onay artery bypass grafting, but it’s well known that in the diabetic patient with two or more vessel disease, the surgical strategy allows the best mid- and long-term re- sults [10]. Moreover, the benefits of CABG surgery remain lim- ited by the life expectancy of the most common type of graft, the saphenous vein. Nearly 40 years after the in- troduction of bypass surgery, the rate of vein graft failure remains at high levels [11]. The introduction of the left internal thoracic artery (LITA) graft radically changed the long term patency Published Online July 2013 in SciRes. http://www.scirp.org/journal/wjcd