Diabetes is a major determinant of atherosclerosis and adverse cardiac events, and portends an adverse prognosis in patients with coronary artery disease regardless of treatment strategy. There is significant association between the HbA1C levels and severity of coronary artery disease (CAD). It is shown in multiple trials that coronary artery bypass grafting (CABG) has significant mortality benefit over percutaneous coronary intervention (PCI) in diabetic population with multivessel disease. The percutaneous treatment of patients with obstructive atherosclerotic disease in coronary saphenous vein bypass grafts (SVGs) remains a challenge in interventional cardiology. This chapter covers the natural history and pathophysiology of saphenous vein graft disease, pathophysiology in diabetic population, percutaneous interventions in venous grafts, indications of PCI in venous grafts, pharmacologic and mechanical strategies to minimize complications during SVG PCI, glycemic control and revascularization.