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

4/15/2016 Bovine, Cryopreserved and Bovine Carotid Artery other Biologic Grafts: When to use them? • BCAG (Artegraft) • Tanned collagen matrix • First used as AVG in 1972 but had reported aneurysmal degeneration Joseph H. Rapp, MD • Manufacturing process has been changed to achieve Professor Emeritus enhanced collagen cross- Department of Surgery linking University of California, San Francisco • Available in various diameters and lengths (10cm to 40cm) Bovine Carotid Artery Bovine Mesenteric Vein • Randomized trial with 26 BCAG and 27 PTFE Kennealey, 2011 • Procol graft • Primary patency 60% vs 10% for PTFE at 1 yr but no difference • More recent addition secondary patency • Processing preserves • No differences in infection, 1 year Primary Secondary elastin content pseudo aneurysm development, steal BCAG 21-73% 60-89% • Available in 10 - 40cm PTFE 10-52% 46-73% • Retrospective reviews lengths • Primary graft Reifsnyder 2015 • Handles like the Saphenous Vein? • Use in challenging settings Harlander-Locke 2014 1

4/15/2016 Cryopreserved Human Bovine Mesenteric Vein Vein • Generally femoral vein • Prospective Study in pts who had previous failed • Large diameters grafts Katzman 2005 • 10-30+ cm • 183 BMV vs 93 Synthetic Secondar Secondar Primary 1 year Primary • Handle carefully, y y • Reduction in infections - aneurysmal degeneration is Cryo 37-49% 69-75% BMVB 35% 65% 10/183 vs 18/93 (p<0.001) a problem Prosthetic 65% 78% Synthetic 28% 55% • Smaller studies report • Good results in population similar patency Tahami 2007, with infections or multiple Widmer 2004 previous graft failures Matsuura 2000 Lin, 2002 Cost Comparison Tissue Engineered Grafts • Over a decade in PTFE $800 development now in Phase 2 trials Artegraft $1,089 • Two companies • Cytograft, Navato, CA Propatent $1,100 • Humacyte, Morrisville, Procol $1,950 NC • Only published data is 60% Cryovein $4,000 - 5,000 patency at 6 months 2

4/15/2016 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. 3