The Efficacy of Endovascular Treatment in FPOD With TASC C and D Lesions
Physician-initiated, Prospective, Multi-center,Observational Study: The Efficacy of Endovascular Treatment in Femoropopliteal Occlusive Disease (FPOD) With TransAtlantic InterSociety Consensus (TASC) C and D Lesions
Based on the development of new tools, including drug coated balloon, paclitaxel eluting stent, interwoven stents, debulking tools, more challenging femoropopliteal arterial lesions have been treated with endovascular procedures.
The TASC D lesion ,especially with popliteal artery involved are often excluded in prospective clinical trials. Therefore, a well-designed real world study that track clinical relevant outcomes, are required to determine the optimal therapies for patients with complex femoropopliteal lesions.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
According to the TASC II guidelines, TASC D lesions was recommended for primary endovascular revascularization, TASC C lesions for surgical revascularization in patients with appropriate perioperative risk and available conduit. However, Based on the development of new tools, including drug coated balloon, paclitaxel eluting stent, interwoven stents, debulking tools, more challenging femoropopliteal arterial lesions have been treated with endovascular procedures.
Despite The shift of Endovascular- first strategy has been documented in recent literature. There still lack evidence to support either approach have a significant advantage over the other. And TASC D lesion ,especially with popliteal artery involved are often excluded in prospective clinical trials. Therefore, a well-designed real world study that track clinical relevant outcomes, are required to determine the optimal therapies for patients with complex femoropopliteal lesions.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Contacts and Locations
Study Contact
Study Contact
- Name: Ni Qihong, M.D.
- Phone Number: +8615801900772
- Email: niqihong1989@163.com
Study Locations
-
-
Shanghai Municipality
-
Shanghai, Shanghai Municipality, China, 200127
- Renji Hospital
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients over 18 years old
- Patients with Rutherford classification range from 3 to 6
- If patients with both lower limbs meeting the inclusion criteria, both side of limb can be selected for this study
- The lower extremity artery needs to have a healthy runoff of no less than 10 cm above the ankle
- The guide wire should pass through the lesion of femoropopliteal artery, and further endovascular treatment is performed. In this study, we did not limit the methods of the guide wire passing through the target lesion
- If the first-time endovascular treatment is failure, patients undergo endovascular treatment successfully at the second time, the patients can still be enrolled
- For patients with aortoiliac artery lesions, they can be enrolled after the successful reconstruction of aortoiliac artery
- Informed consent signed by patients
Exclusion Criteria:
- Patients who are unwilling or refuse to sign the informed consent form
- Patients with acute and subacute lower extremity arterial thrombosis or arterial embolism
- Patients with thromboangiitis obliterans
- Patients with failure of endovascular treatment, and transferred to bypass surgery
- Patients who underwent surgical atherectomy for common femoral artery occlusive lesions
- Patients with known allergy to heparin, low molecular weight heparin and contrast agents
- Patients who have been enrolled in other clinical trials in the past 3 months
- Women during pregnancy and lactation
- Patients with other diseases that may lead to difficulties in the trial or significantly shorten the life expectancy (< 3 years), such as tumors, severe liver disease, cardiac insufficiency
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Crossover
- Time Perspectives: Prospective
Number of groups / cohorts
Cohorts and Interventions
Group / CohortGroup / Cohort |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Group A:TASC C lesion group
Multiple stenoses or occlusions totaling >15cm or recurrent stenoses or occlusions that need treatment after endovascular interventions (300 cases)
|
All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach.
If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed.
Surgeons can choose treatment methods according to the characteristics of the lesions.
For example: (a) Plain old balloon angioplasty; (b) Drug-coated balloon angioplasty; (c) Drug-coated balloon angioplasty + provisional stenting; (d) Bare-metal stent implantation; (e) Stent graft implantation; (f) Directional atherectomy + drug-coated balloon angioplasty, (g) Drug -eluting stent.
|
|
Group B:TASC D lesion with common femoral artery involved
Chronic total occlusions >20cm with common femoral artery involved (100 cases)
|
All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach.
If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed.
Surgeons can choose treatment methods according to the characteristics of the lesions.
For example: (a) Plain old balloon angioplasty; (b) Drug-coated balloon angioplasty; (c) Drug-coated balloon angioplasty + provisional stenting; (d) Bare-metal stent implantation; (e) Stent graft implantation; (f) Directional atherectomy + drug-coated balloon angioplasty, (g) Drug -eluting stent.
|
|
Group C:TASC D lesion with proximal popliteal artery involved
Chronic total occlusions >20cm with proximal popliteal artery involved (300 cases)
|
All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach.
If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed.
Surgeons can choose treatment methods according to the characteristics of the lesions.
For example: (a) Plain old balloon angioplasty; (b) Drug-coated balloon angioplasty; (c) Drug-coated balloon angioplasty + provisional stenting; (d) Bare-metal stent implantation; (e) Stent graft implantation; (f) Directional atherectomy + drug-coated balloon angioplasty, (g) Drug -eluting stent.
|
|
Group D:TASC D lesion with distal popliteal artery involved
Chronic total occlusions >20cm with distal popliteal artery involved (200 cases)
|
All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach.
If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed.
Surgeons can choose treatment methods according to the characteristics of the lesions.
For example: (a) Plain old balloon angioplasty; (b) Drug-coated balloon angioplasty; (c) Drug-coated balloon angioplasty + provisional stenting; (d) Bare-metal stent implantation; (e) Stent graft implantation; (f) Directional atherectomy + drug-coated balloon angioplasty, (g) Drug -eluting stent.
|
|
Group E:TASC D lesion with popliteal artery and proximal trifurcation vessels involved
Chronic total occlusion of popliteal artery (P1-3 segment) with proximal trifurcation vessels involved (100 cases)
|
All the patients are treated by endovascular therapy, through contralateral femoral artery approach, ipsilateral antegrade femoral artery approach or brachial artery approach.
If the lesion is difficult to pass in antegrade approach, retrograde puncture at the distal artery of the lesion can be performed.
Surgeons can choose treatment methods according to the characteristics of the lesions.
For example: (a) Plain old balloon angioplasty; (b) Drug-coated balloon angioplasty; (c) Drug-coated balloon angioplasty + provisional stenting; (d) Bare-metal stent implantation; (e) Stent graft implantation; (f) Directional atherectomy + drug-coated balloon angioplasty, (g) Drug -eluting stent.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Technical success rate
Time Frame: 7 days
|
Technical success refers to 1. Establishment of continuous blood flow, no early occlusion, acute thrombosis or reintervention driven by target lesion within 7 days after operation
|
7 days
|
|
Incidence of major adverse events
Time Frame: 36 months
|
major adverse events
|
36 months
|
|
Target vessel patency rate evaluated by postoperative ultrasound
Time Frame: 36 months
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Target vessel patency rate
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36 months
|
|
Clinical-driven Target lesion reintervention rate
Time Frame: 36 months
|
Target lesion reintervention rate
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36 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Clinical-driven Target lesion reintervention rate
Time Frame: 24 months
|
Target lesion reintervention rate
|
24 months
|
|
Direct medical expenses (3-year cumulative hospitalization expenses and endovascular expenses related to target lesions)
Time Frame: 36 months
|
Direct medical expenses
|
36 months
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
Other Study ID Numbers
- The Oriental Study
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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