Bovine Carotid Artery Graft connecting to a human leg.

Bovine Carotid Artery Graft: A Promising Solution for Leg Bypass?

Beau Callahan in Health & Wellness November 2025 • 4 min read.

"Exploring the Long-Term Success of Artegraft in Lower Extremity Revascularization"

For years, biological grafts have played a vital role as vascular conduits in leg bypass surgeries. However, information specifically on bovine carotid artery grafts (BCAG) in lower extremity revascularization has been limited. This article explores the outcomes of lower leg bypass procedures using BCAG, offering insights into its effectiveness and long-term results.

This analysis is based on a retrospective review of a prospectively collected database, examining patients who underwent lower extremity bypass using BCAG from 2002 to 2017. The study focused on clinical outcomes, including graft patency (how long the graft stays open and functional) and limb salvage rates.

A total of 124 BCAG (Artegraft, North Brunswick, NJ) were implanted in 120 patients for lower extremity revascularization. The surgical indications varied, including disabling claudication (12%), rest pain (36%), tissue loss (48%), and infected prosthetic graft replacement (3%). In a significant number of cases (72%), the patient's own saphenous vein was either inadequate or absent, making BCAG a crucial alternative.

Why Choose BCAG for Lower Extremity Bypass?

Bovine Carotid Artery Graft connecting to a human leg.

BCAG was used in 46 patients (37%) who had a prior failed ipsilateral leg bypass. The distal anastomosis, where the graft connects to the artery, was performed in different locations: above-knee popliteal artery (25%), below-knee popliteal artery (26%), and tibial artery (39%). Notably, a distal anastomotic patch was created in all tibial artery cases to allow for BCAG-tibial reconstruction.

The study revealed promising long-term results. The yearly primary patency rates, indicating how well the graft remained open, were 86.5%, 76.4%, 72.2%, 68.3%, and 67.5% over five years, respectively. Secondary patency rates, which account for interventions to maintain graft function, were even higher at 88.5%, 84.7%, 82.4%, 78.5%, and 75.6%.

Compliant.
Thromboresistant.
Durable.
Easy to handle with surgical manipulation and suturing.

The limb salvage rate at one year was 83.6%, and at five years, it stood at 86.2% for patients with critical limb ischemia, a severe condition characterized by reduced blood flow to the limbs. Multivariate analysis identified a poor runoff score (P = 0.03, 95% CI, 1.3–5.3; OR, 1.6) as independently associated with graft occlusion.

The Future of BCAG in Vascular Surgery

BCAG emerges as a reliable vascular conduit, offering good long-term results in lower extremity bypass procedures. This is particularly significant for patients lacking suitable autologous vein grafts.

BCAG offers several advantages. Biological grafts are associated with a lower risk of infection and enhanced graft anastomotic compliance due to their vessel elasticity, while BCAG's structural elasticity and ease of handling during suturing contribute to its appeal among surgeons.

While this study provides valuable insights, further prospective research is needed to compare BCAG with autogenous vein grafts directly. This will help refine our understanding of BCAG's role in lower extremity revascularization and optimize patient outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00268-017-4161-x, Alternate LINK

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

Subject: Surgery

Journal: World Journal of Surgery

Publisher: Springer Science and Business Media LLC

Authors: Philip Lindsey, Angela Echeverria, Mathew Cheung, Elias Kfoury, Carlos F. Bechara, Peter H. Lin

Published: 2017-08-17

Everything You Need To Know

What exactly is a bovine carotid artery graft (BCAG) and how is it used in leg bypass surgery?

A bovine carotid artery graft (BCAG), such as Artegraft, is a biological graft sourced from a cow's carotid artery. It's surgically implanted to bypass blocked arteries in the leg, restoring blood flow. BCAGs are particularly useful when a patient's own saphenous vein isn't suitable for a traditional bypass.

Under what circumstances would a surgeon opt for a bovine carotid artery graft (BCAG) like Artegraft, over using a patient's own vein for a lower extremity bypass?

BCAG's were chosen when patients needed lower extremity bypass surgery and their own saphenous vein was either inadequate or absent in 72% of cases. Additionally, BCAG was utilized in 37% of patients who had a prior failed ipsilateral leg bypass. Indications for lower extremity revascularization with BCAG also included disabling claudication, rest pain, tissue loss, and infected prosthetic graft replacement.

What are the long-term success rates, specifically primary and secondary patency, observed with bovine carotid artery grafts (BCAG) in lower extremity bypass procedures?

Primary patency rates for BCAG, which indicate how well the graft remains open, were 86.5%, 76.4%, 72.2%, 68.3%, and 67.5% over five years, respectively. Secondary patency rates, accounting for interventions to maintain graft function, were even higher at 88.5%, 84.7%, 82.4%, 78.5%, and 75.6%. These results show good long-term functionality of the graft.

What does 'poor runoff score' mean, and why does it matter for patients who have received a bovine carotid artery graft (BCAG) in their leg?

A poor runoff score was identified as independently associated with graft occlusion after BCAG implantation. Runoff score refers to the quality of the arteries downstream from the bypass graft. A lower runoff score indicates poorer arterial health and reduced blood flow in the lower leg and foot, increasing the risk of graft failure.

Besides graft patency and limb salvage, what other outcomes are important to consider when evaluating the success of bovine carotid artery grafts (BCAG) in patients with critical limb ischemia?

Beyond limb salvage and graft patency, other factors influence the overall success and patient satisfaction following BCAG implantation. These include monitoring for infection, managing risk factors like diabetes and smoking, and assessing the patient's overall functional status and quality of life. Future research could explore the impact of these factors and compare BCAG outcomes with other graft types.