(IP241) Long-term Durability of Bovine Carotid Artery Conduit Usage in Arteriovenous Fistula/Graft Revision

Objectives: We investigated the technical outcomes and durability of bovine carotid artery (BCA) conduits used for arteriovenous fistula/graft (AVF/AVG) revision.

Methods: Retrospective, single-center study of 51 patients (52 BCA conduits) who underwent AVF/AVG revision using Artegrafts between 2012 and 2024. The study assessed patient demographics, comorbidities, conduit characteristics, perioperative management, and revision outcomes. Key outcomes included primary, primary-assisted, and secondary patency rates at 6 months, 1 year, and 2 years post-revision. Technical success was measured in terms of time to first cannulation, volumetric flow, and complications.

Results: The study population had a mean age of 61 years (±16), was predominantly Black (63%), and primarily male (59%). A majority of patients had their index AVF/AVG in the left upper extremity (81%), and the majority had cardiac comorbidities: CAD (45%), heart failure (43%), and hypertension (100%) (Table I).
Most revisions were elective (71%); however, a large proportion (29%) presented emergently for acute ulceration or hemorrhage. Most revisions were for aneurysmal degeneration/ulceration (77%). Index conduits prior to revision had an average age of 3 years (±3). Revisions were either interposition BCA conduit (92%) or reconstruction (8%). Proximal and distal anastomoses were to the prior fistula at 83% and 62% respectively, although over 33% had their distal anastomosis at a new outflow vein site. Most BCA conduits used were 7mm in diameter (52%). (Table II)
There were no intraoperative complications, and 30-day complications were rare (2%). Primary patency was 80%, 64%, and 71% at 6 months, 1 year, and 2 years, respectively. Primary-assisted patency at the same intervals was 90%, 79%, and 71%. Secondary patency was 94%, 87%, and 81% (Fig 1 and 2). The average time to first cannulation was 44 days (±23). On immediate post-op follow-up, mean volumetric flow was 1587 ml/min (±726), with 10% of patients demonstrating >50% stenosis on duplex surveillance. (Table III).
Revision infection occurred in 14 cases; however, four patients had infections in their excluded fistula/graft, rather than in their newly implanted BCA conduit.

Conclusions: This study suggests that BCA conduits provide durable patency with low procedural complication rates. Artegraft conduits experienced high primary assisted and secondary patency rates. In addition, this study found them to be highly resistive to infection. The use of BCA as an interposition conduit provides a reliable conduit with minimal perioperative complications.