[Arterial grafts in coronary surgery for diabetic patients].
Surgical revascularization allows especially for the diabetic patient with coronary multi-vessel disease a superior long-termperspective compared to percutaneous coronary interventions. However, the specific advantages and also risks associated with the expanded use of arterial grafts as coronary conduits in diabetics are not clearly answered. A systemic analysis of the current literature underlines the following statements: The radial artery is, compared to the internal mammary artery, to a higher extent prone to atherosclerosis, especially in diabetic patients. Better long-term survival for patients with bilateral IMA-grafts has also been assessed for diabetic patients. The risk of thoracic wound infections is not obligatory increased for diabetics with double IMA-grafts. Revascularization with radial arteries can be performed with low perioperative risks. Long-term results or studies on radial artery bypass grafting especially in diabetics are not available. In our own experience (3,548 isolated coronary operations, 01/2001 until 05/2005), diabetic patients have no increased perioperative mortality, even when using more complex arterial grafting. Conclusively, diabetic patients should also significantly benefit from the use of the second mammary artery. Regarding conduit quality, a second IMA appears favorable over the radial artery.
Cremer
J
J
Klinik für Herz- und Gefässchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel. JCremer@kielheart.uni-kiel.de
Böning
A
A
Fraund
S
S
Schöneich
F
F
Lutter
G
G
Rahimi-Barfeh
A
A
D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery*; D048909:Diabetes Complications; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008323:Mammary Arteries / Q000637:transplantation; D017534:Radial Artery / Q000637:transplantation; D015996:Survival Rate