- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01271881
Placement of Covered Stents to Treat Hemodialysis Access Stenoses in the Cephalic Arch and Central Veins
Balloon angioplasty is used to open up a narrowing that forms in hemodialysis fistula. Two areas of particular problems are the terminal portion of the cephalic vein near the shoulder and the central veins in the chest. Although angioplasty is standard of care the treated narrowed segments of vein mostly renarrow within 3 months requiring retreatment to keep your dialysis access functional. Recently there has been introduction of a new technology called a covered stent graft. Initial studies suggest that placing this device across the area of narrowing leads to dialysis access staying open longer and needing less angioplasty treatments.
This study is designed to compare angioplasty (standard of care) versus using a covered stent graft. The investigators will then look at the dialysis records and future fistulograms to see if there is decreased flow through the fistula at 3, 6 and 12 months after the initial procedure.
Study Overview
Status
Conditions
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Abigail Falk, Dr.
- Phone Number: 914-683-9731
- Email: abigailfalk123@pol.net
Study Contact Backup
- Name: Claudio Cantu, RPA
- Phone Number: 914-683-9729
- Email: CCantu@aac-llc.com
Study Locations
-
-
New York
-
Bronx, New York, United States, 10461
- Recruiting
- American Access Care of Bronx
-
Contact:
- Abigail Falk, Dr.
- Phone Number: 718-794-9729
- Email: abigailfalk123@pol.net
-
Principal Investigator:
- Abigail Falk, Dr.
-
Flushing, New York, United States, 11366
- Recruiting
- American Access Care of Queens
-
Contact:
- Kiran Jotwani, MD
- Phone Number: 718-820-9729
-
Principal Investigator:
- Kiran Jotwani, MD
-
White Plains, New York, United States, 10601
- Recruiting
- Access Care Physicians of New York
-
Contact:
- Claudio Cantu, RPA
- Phone Number: 914-683-9729
- Email: CCacntu@aac-llc.com
-
Principal Investigator:
- Claudio Cantu, RPA
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Hemodialysis patient with a mature forearm or upper arm access that was created > 2 months before enrollment in study.
- The patient is ≥ 18 years of age.
- The patient has a reasonable expectation of remaining on hemodialysis for 12 months.
- The patient or his/her legal guardian understands the study and is willing and able to comply with follow-up requirements.
- The patient or his/her legal guardian is willing to provide informed consent.
- The patient has lesions that meet the angiographic inclusion / exclusion criteria and induce clinical, hemodynamic or functional abnormality.
Exclusion Criteria:
- The patient has a known or suspected systemic infection.
- The patient has a known or suspected infection of the hemodialysis access and / or bacteremia.
- The patient is currently taking maintenance immunosuppressant medication such as rapamycin, mycophenolate or mycophenolic acid, prednisone (>10 mg per day), cyclosporine, tacrolimus, or cyclophosphamide.
- The patient has known bleeding disorder (e.g., hemophilia or von Willebrand's disease).
- The patient has known sensitivity to heparin.
- The patient is scheduled for a live donor kidney transplant.
- The patient is enrolled in another investigational study or another access maintenance trial
- The patient has comorbid conditions that may limit their ability to comply with the follow-up requirements
- Life expectancy is ≤ 24 months.
- The patient has an untreatable allergy to radiographic contrast material.
- The patient is pregnant.
- In the opinion of the operating physician, the patient's hemodialysis access circuit is unsuitable for endovascular treatment.
- The patient's access is planned to be abandoned within 1 year.
- The patient has indwelling catheters (dialysis, pacemakers, ports).
- The patient has a central vein stent that would lead to jailing of the internal jugular vein.
- The patient experiences angioplasty-induced venous rupture.
- The patient has a flow limiting dissection after angioplasty.
- The patient's hemodialysis access is thrombosed.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Percutaneous Transluminal Angioplasty (PTA) alone
Intervention: Procedure: PTA alone without use of the GORE VIABAHN
|
PTA alone with no stent used
|
Experimental: PTA with covered stent
GORE VIABAHN® Endoprosthesis with Heparin Bioactive Surface
|
Covered stent produced by GORE VIABAHN
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Primary patency at 3, 6, and 12 months
Time Frame: 1 year
|
Target lesion primary patency at 3, 6, and 12 months
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Secondary patency at 3, 6, and 12 months
Time Frame: 1 year
|
Target lesion secondary patency at 3, 6, and 12 months, access circuit primary and secondary patency at 3, 6, and 12 months, anatomic, clinical, and procedural success.
Adverse events through 1 month
|
1 year
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Abigail Falk, Dr., American Access Care Physician
- Study Chair: Claudio Cantu, RPA, American Access Care Center Operations Manager
Publications and helpful links
General Publications
- Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee. J Vasc Interv Radiol. 1999 Nov-Dec;10(10):1405-15. doi: 10.1016/s1051-0443(99)70252-6. No abstract available.
- Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, Miller A, Scher L, Trerotola S, Gregory RT, Rutherford RB, Kent KC. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002 Mar;35(3):603-10. doi: 10.1067/mva.2002.122025.
- Chang CJ, Ko PJ, Hsu LA, Ko YS, Ko YL, Chen CF, Huang CC, Hsu TS, Lee YS, Pang JH. Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis. Am J Kidney Dis. 2004 Jan;43(1):74-84. doi: 10.1053/j.ajkd.2003.09.015.
- Patel RI, Peck SH, Cooper SG, Epstein DM, Sofocleous CT, Schur I, Falk A. Patency of Wallstents placed across the venous anastomosis of hemodialysis grafts after percutaneous recanalization. Radiology. 1998 Nov;209(2):365-70. doi: 10.1148/radiology.209.2.9807560.
- Rajan DK, Clark TW. Patency of Wallstents placed at the venous anastomosis of dialysis grafts for salvage of angioplasty-induced rupture. Cardiovasc Intervent Radiol. 2003 May-Jun;26(3):242-5. doi: 10.1007/s00270-003-2706-x.
- Haage P, Vorwerk D, Piroth W, Schuermann K, Guenther RW. Treatment of hemodialysis-related central venous stenosis or occlusion: results of primary Wallstent placement and follow-up in 50 patients. Radiology. 1999 Jul;212(1):175-80. doi: 10.1148/radiology.212.1.r99jl21175.
- Vogel PM, Parise C. SMART stent for salvage of hemodialysis access grafts. J Vasc Interv Radiol. 2004 Oct;15(10):1051-60. doi: 10.1097/01.RVI.0000129915.48500.DC.
- Rajan DK, Saluja JS. Use of nitinol stents following recanalization of central venous occlusions in hemodialysis patients. Cardiovasc Intervent Radiol. 2007 Jul-Aug;30(4):662-7. doi: 10.1007/s00270-007-9083-9.
- Chan MR, Bedi S, Sanchez RJ, Young HN, Becker YT, Kellerman PS, Yevzlin AS. Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistulae. Clin J Am Soc Nephrol. 2008 May;3(3):699-705. doi: 10.2215/CJN.04831107. Epub 2008 Feb 6.
- Pan HB, Liang HL, Lin YH, Chung HM, Wu TH, Chen CY, Fang HC, Chen CK, Lai PH, Yang CF. Metallic stent placement for treating peripheral outflow lesions in native arteriovenous fistula hemodialysis patients after insufficient balloon dilatation. AJR Am J Roentgenol. 2005 Feb;184(2):403-9. doi: 10.2214/ajr.184.2.01840403.
- Shemesh D, Goldin I, Zaghal I, Berlowitz D, Raveh D, Olsha O. Angioplasty with stent graft versus bare stent for recurrent cephalic arch stenosis in autogenous arteriovenous access for hemodialysis: a prospective randomized clinical trial. J Vasc Surg. 2008 Dec;48(6):1524-31, 1531.e1-2. doi: 10.1016/j.jvs.2008.07.071. Epub 2008 Oct 1.
- Naoum JJ, Irwin C, Hunter GC. The use of covered nitinol stents to salvage dialysis grafts after multiple failures. Vasc Endovascular Surg. 2006 Aug-Sep;40(4):275-9. doi: 10.1177/1538574406291803.
- Gupta M, Rajan DK, Tan KT, Sniderman KW, Simons ME. Use of expanded polytetrafluoroethylene-covered nitinol stents for the salvage of dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol. 2008 Jun;19(6):950-4. doi: 10.1016/j.jvir.2008.03.016. Epub 2008 Apr 28.
- Clark TW, Rajan DK. Treating intractable venous stenosis: present and future therapy. Semin Dial. 2004 Jan-Feb;17(1):4-8. doi: 10.1111/j.1525-139x.2004.17103.x.
- Yuan JG, Ohki T, Marin ML, Quintos RT, Krohn DL, Beitler JJ, Veith FJ. The effect of nonporous PTFE-covered stents on intimal hyperplasia following balloon arterial injury in minipigs. J Endovasc Surg. 1998 Nov;5(4):349-58. doi: 10.1583/1074-6218(1998)0052.0.CO;2.
- Fontaine AB, Dos Passos S, Spigos D, Cearlock J, Urbaneja A. Use of polyetherurethane to improve the biocompatibility of vascular stents. J Endovasc Surg. 1995 Aug;2(3):255-65. doi: 10.1583/1074-6218(1995)0022.0.CO;2.
Helpful Links
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- GORE-01
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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