Autogenous Great Saphenous Vein Graft Bypass versus Stenting in Cath Lab in treatment of Long Segment Superficial Femoral Artery Occlusion- Our Experience in Bangladesh

Abstract

Background: Long-segment superficial femoral artery (SFA) occlusion poses significant challenges in peripheral arterial disease management. While Autogenous great saphenous vein (GSV) bypass grafting remains the gold standard, endovascular stenting has emerged as a less invasive alternative. This study compares the outcomes of these two approaches in a Bangladeshi cohort.

Objective: To evaluate the efficacy of GSV graft bypass versus catheterization laboratory (cathlab) stenting for long-segment SFA occlusion.

Methods: This prospective comparative study was conducted at Bangladesh Medical University (Ex BSMMU), Shahbag, Dhaka and IBN SINA Specialized Hospital, Dhanmondi, Dhaka from January 2022 to July 2024. Thirty patients with long-segment SFA occlusion (>15 cm) were enrolled via purposive sampling and randomly allocated to either GSV bypass (n=15) or stenting (n=15) groups. Primary endpoints included procedural success, patency rates at 6 and 12 months, and complication rates. Secondary endpoints comprised anklebrachial index (ABI) improvement and quality-of-life measures. Data were analyzed using SPSS version 23.0, with statistical significance set at p<0.05.

Results: The study demonstrated superior outcomes with GSV bypass versus stenting for long-segment SFA occlusions. At 12-month follow-up, GSV bypass showed significantly higher primary patency (86.7% vs 60.0%, p=0.032) and lower target lesion revascularization rates (13.3% vs 40.0%, p=0.041). While stenting offered shorter hospital stays (2.1 vs 5.3 days, p<0.001), it had higher restenosis rates (46.7% vs 20.0%, p=0.042). Quality-of-life measures also favored bypass (p=0.039).

Conclusion: GSV bypass remains the preferred treatment for long-segment SFA occlusions in suitable candidates, offering better durability. Stenting provides a viable alternative for high-risk cases. These findings support context-specific treatment algorithms in resource-limited settings, emphasizing the need for both surgical and endovascular capabilities.

University Heart Journal 2025; 21(1): 31-34