Role of multimodality imaging in diabetic patients undergoing vascular bypass surgery: a narrative review

Diabetes mellitus significantly increases the burden of coronary artery disease and peripheral arterial disease, frequently necessitating vascular bypass surgery. Imaging plays a central role across the perioperative continuum, from preoperative risk stratification and surgical planning to intraoperative guidance and postoperative surveillance. This narrative review synthesizes current evidence on the application of multimodality imaging in diabetic patients undergoing coronary artery bypass grafting and peripheral arterial bypass procedures. A structured literature search of major databases was undertaken to identify contemporary studies evaluating echocardiography, computed tomography angiography, duplex ultrasound, magnetic resonance angiography, digital subtraction angiography, and functional nuclear imaging. Diabetic-specific factors such as diffuse multivessel disease, medial arterial calcification, renal impairment, and microvascular dysfunction substantially influence imaging performance and modality selection. While noninvasive imaging increasingly guides surgical decision-making and follow-up, the available evidence remains heterogeneous and largely observational. Advanced and hybrid imaging techniques show promise for individualized care but are limited by cost, availability, and a lack of robust outcome-driven data. Standardized imaging pathways and higher-quality comparative studies are required to optimize perioperative imaging strategies in this high-risk population.