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Most diabetics eventually develop atherosclerosis, and there are two basic surgical options, stents and bypass. Recent headlines tout the superiority of bypass to stents for most people, but there are differences in treating people who have diabetes.

Sooner or later, most diabetics wind up with coronary artery disease. The combination of years of high blood pressure, high triglycerides, high cholesterol, and inflammation team up with imperfect injury repair to create clogs in coronary arteries, and at some point, it's just not possible to keep on going without getting blood vessels open again.

Many diabetics, of course, manage to "bypass bypass" for a very long time, but it's possible to reach a point that arteries have to get repaired and they have to get repaired now.

When that happens, interventional cardiologists offer angioplasty, percutaneous coronary intervention (also known as stents), and coronary artery bypass grafts (also known just as bypass).

You don't want to get on the operating table, as I did, and learn that your doctor has gone for the low-cost option that will require more surgery later, when you are just awake enough to hear what is going on and not awake enough to raise your hand and object. Here's what every diabetic needs to know about surgical heart repair options, preferably before they are being put under anesthesia.

What Are the Options for Fixing Clogged Arteries in Diabetics?

If statins or chelation therapy or diet or orthomolecular supplementation programs have not worked, and you need vascular repair and you need it now, doctors have three general options:

  • Angioplasty. This consists of placing a balloon into a blood vessel, inflating it, moving it around, and breaking up cholesterol deposits inside an artery. The surgeon uses a tiny camera on the end of a catheter to see the lesions and to monitor progress of the procedure.
  • Stent. This consists of insert a wire mesh coil into an artery to keep it open after cholesterol deposits have been broken up. This almost always follows angioplasty.
  • Bypass. The surgeon takes a vein from a leg and then opens the chest to attach it to the coronary artery. Usually the heart has to be stopped and the patient placed on a bypass machine to take care of oxygenating and circulating blood during the procedure.

Recovery from angioplasty and stents can be very fast. Some patients go home the same day and feel great. Recovery from bypass is much slower. It's not unusual for it to take a year for patients to get back to feeling normal. But doctors don't always tell their diabetic patients everything they need to know about their cardiovascular repair options.

Continue reading after recommendations

  • Abdallah MS, Wang K, Magnuson EA, Spertus JA, Farkouh ME, Fuster V, Cohen DJ
  • FREEDOM Trial Investigators. Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. JAMA. 2013 Oct 16. 310(15):1581-90. doi: 10.1001/jama.2013.279208.
  • Serruys PW, Ong AT, van Herwerden LA, Sousa JE, Jatene A, Bonnier JJ, Schönberger JP, Buller N, Bonser R, Disco C, Backx B, Hugenholtz PG, Firth BG, Unger F. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol. 2005 Aug 16. 46(4):575-81.
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