World Journal of Surgery

, Volume 42, Issue 1, pp 295–301 | Cite as

Lower Extremity Bypass Using Bovine Carotid Artery Graft (Artegraft): An Analysis of 124 Cases with Long-Term Results

  • Philip Lindsey
  • Angela Echeverria
  • Mathew Cheung
  • Elias Kfoury
  • Carlos F. Bechara
  • Peter H. LinEmail author
Original Scientific Report



Although biological grafts have been utilized as a vascular conduit in leg bypass for many years, reports of a bovine carotid artery graft (BCAG) in lower extremity revascularization have been scarce. This study analyzed the outcome of lower leg bypass using BCAG.


A retrospective review of a prospectively collected database of all patients undergoing lower extremity bypass using BCAG from 2002 to 2017 was performed. Clinical outcomes including graft patency and limb salvage were evaluated.


A total of 124 BCAG (Artegraft, North Brunswick, NJ) were implanted in 120 patients for lower extremity revascularization. Surgical indications included disabling claudication in 12%, rest pain in 36%, tissue loss in 48%, and infected prosthetic graft replacement in 3%. Autologous saphenous vein was either inadequate or absent in 72% of patients. BCAG was used in 46 patients (37%) who had a prior failed ipsilateral leg bypass. Distal anastomosis was performed in the above-knee popliteal artery, below-knee popliteal artery, and tibial artery in 30 cases (25%), 32 cases (26%), and 48 cases (39%), respectively. Distal anastomotic patch was created in all tibial artery to allow BCAG-tibial reconstruction. The yearly primary patency rates in 5 years were 86.5, 76.4, 72.2, 68.3, and 67.5%, respectively. The corresponding yearly secondary patency rates were 88.5, 84.7, 82.4, 78.5, and 75.6%, respectively. The limb salvage rate at one year was 83.6% and at five years was 86.2% for patients with critical limb ischemia. Multivariate analysis showed poor runoff score (P = 0.03, 95% CI, 1.3–5.3; OR, 1.6) was independently associated with graft occlusion.


BCAG is an excellent vascular conduit and provides good long-term results in lower extremity bypass.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  1. 1.Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonUSA
  2. 2.Univesity Vascular AssociatesLos AngelesUSA
  3. 3.Department of Cardiothoracic and Vascular SurgeryHouston Methodist HospitalHoustonUSA

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