PC198. Bovine Carotid Graft as a Conduit in Arterial Trauma

Abstract

Although endovascular management of traumatic arterial injuries has become more common over the years, open reconstruction remains the mainstay of treatment. Autogenous vein is the preferred conduit for elective bypass, and, when feasible, traumatic injuries. When autogenous conduit is not available, or time does not permit harvest, bovine carotid artery graft (Artegraft, BCAG) is an option. While BCAG has been used for peripheral arterial disease treatment, there is Nothing to disclose on its use in vascular trauma. The purpose of this study was to review the experience with BCAG in vascular trauma at a single level 1 trauma center. The medical records of all patients with traumatic arterial injuries who underwent vascular bypass or interposition with bovine carotid artery from April 2014 to -October 2016 were retrospectively reviewed. Patient records were examined for patency, infection, and limb salvage. BCAG was used in 11 cases of arterial trauma which required open arterial reconstruction. For patients managed with BCAG, 8 were owing to penetrating trauma and 3 to blunt trauma. Patients ranged in age from 22 to 70 years (mean 35.8 years), eight male (73%), and three female (27%). Eighty-two percent involved the lower extremities, 9% involved the upper extremities, and 9% involved the carotid artery. Interventions included two iliofemoral, one femoral to above knee popliteal, two femoral to below knee popliteal or tibial, three SFA interposition grafts, one below the knee popliteal to tibial, one ulnar to radial bypass, and one carotid interposition. Follow-up ranged between 2 and 24 months (mean, 14 months). Based on most recent follow-up data, 64% of grafts had primary patency, while 82% had primary assisted patency. One graft occluded at 4 months in a patient with a posterior knee dislocation with a viable limb after failed attempts at graft salvage. There were no cases of graft or wound infection. There was one early failure, with resultant above knee amputation, on postoperative day 1. There were no deaths. While autologous vein remains the conduit of choice when feasible, traumatic situations do not always permit its use. BCAG is a suitable choice for traumatic arterial injuries when autogenous tissue is not available, either owing to time constraints or absence of suitable conduit. Further research will be needed to determine if BCAG is superior to prosthetic grafts for the trauma patients with arterial injuries.