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[Specificity of the management of atheromatous disease in diabetic renal failure].

Atheromatous disease is particularly common and severe in diabetics with renal failure. The prognosis depends on specific therapeutic measures: in this article, the authors will limit the discussion to the management of coronary artery disease. The cardiovascular risk factors must be treated intensively and corrected. The outlook of these patients also depends on the diagnosis of silent ischaemia with a stress test every two years and the prevention of acute renal failure after coronary angiography. Myocardial revascularisation improves the prognosis of high risk coronary patients. The choice of mode of revascularisation depends on the anatomy of the coronary lesions, the surgical risk and the presence of associated valve disease. The results of coronary angioplasty have been improved by the optimisation of anti-thrombotic treatment and the use of active stents. Despite revascularisation, short and medium-term mortality remains much higher than that of non-diabetics with normal renal function. Non-invasive investigations for residual ischaemia are justified 6 months after angioplasty for diagnosing restenosis and, thereafter, every year to detect progression of the atherosclerosis.