Bovine Carotid Artery other Biologic Grafts: When to use them? - - PowerPoint PPT Presentation

4/15/2016 1

Bovine, Cryopreserved and

• ther Biologic Grafts: When to

use them?

Joseph H. Rapp, MD Professor Emeritus Department of Surgery University of California, San Francisco

Bovine Carotid Artery

• BCAG (Artegraft)
• Tanned collagen matrix
• First used as AVG in 1972 but

had reported aneurysmal degeneration

• Manufacturing process has

been changed to achieve enhanced collagen cross- linking

• Available in various

diameters and lengths (10cm to 40cm)

Bovine Carotid Artery

• Randomized trial with 26 BCAG

and 27 PTFE Kennealey, 2011

• Primary patency 60% vs 10% for

PTFE at 1 yr but no difference secondary patency

• No differences in infection,

pseudo aneurysm development, steal

• Retrospective reviews
• Primary graft Reifsnyder 2015
• Use in challenging settings

Harlander-Locke 2014

1 year Primary Secondary BCAG 21-73% 60-89% PTFE 10-52% 46-73%

Bovine Mesenteric Vein

• Procol graft
• More recent addition
• Processing preserves

elastin content

• Available in 10 - 40cm

lengths

• Handles like the Saphenous

Vein?

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Bovine Mesenteric Vein

• Prospective Study in pts

who had previous failed grafts Katzman 2005

• 183 BMV vs 93 Synthetic
• Reduction in infections -

10/183 vs 18/93 (p<0.001)

• Smaller studies report

similar patency Tahami 2007,

Widmer 2004

1 year Primary Secondar y BMVB 35% 65% Synthetic 28% 55%

Cryopreserved Human Vein

• Generally femoral vein
• Large diameters
• 10-30+ cm
• Handle carefully,

aneurysmal degeneration is a problem

• Good results in population

with infections or multiple previous graft failures

Matsuura 2000 Lin, 2002

Primary Secondar y Cryo 37-49% 69-75% Prosthetic 65% 78%

Cost Comparison

PTFE $800 Artegraft $1,089 Propatent $1,100 Procol $1,950 Cryovein $4,000 - 5,000

Tissue Engineered Grafts

• Over a decade in

development now in Phase 2 trials

• Two companies
• Cytograft, Navato, CA
• Humacyte, Morrisville,

NC

• Only published data is 60%

patency at 6 months

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Summary Biologic Graft for AV Access

• Bovine artery, mesenteric vein and cryopreserved human

femoral vein probably have comparable patency to prosthetic grafts.

• Patency may be improved over PTFE in “disadvantaged”

settings such as leg grafts of where risk of infection is high

• Shorter lengths an alternative for fistula rescue
• There are differences in handling characteristics and cost
• This is such a common procedure. We really should have

better data to guide us.