- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02728817
Evaluation of the Radial Artery Deviation And Reimplantation Technique for Primary Hemodialysis Access Creation (RADAR)
Evaluation of the Radial Artery Deviation And Reimplantation Technique for Primary Hemodialysis Access Creation: a Multicenter Randomized Controlled Trial
The Radial Artery Deviation And Reimplantation (RADAR) technique is a new approach for the construction of hemodialysis arteriovenous fistula. In this technique, the radial artery pedicle is deviated towards the minimally dissected cephalic vein at the wrist. The aim of this study is to compare the safety and efficacy of this technique with the traditional end-cephalic to side-radial arteriovenous fistula, currently used as a first line vascular access in hemodialysis patients.
The hypothesis is that the minimal dissection concept used in the RADAR inhibits venous juxta-anastomotic neointimal hyperplasia and stenosis, and lead to higher rates of maturation and patency.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In current nephrology and vascular surgery guidelines, end-cephalic to side-radial arteriovenous fistula is the gold standard for primary vascular access creation. However, these wrist AVFs are recognized to have the worst patency of any autogenous vascular accesses. Outcome improvement is therefore urgent in the field of vascular access, which concerns a growing incident population of patients with end-stage renal disease requiring hemodialysis.
Primary AVF failure, including failure to mature, occurs in ~35-40% in just the first year, generally due to juxta-anastomotic stenosis. Many AVF subsequently require additional interventions to mature successfully. The primary patency for these AVFs is poor with 55% at 12 months.
Juxta-anastomotic neointimal hyperplasia typically occurs in the swing segment, e.g. the proximal vein mobilized to form the end-to-side anastomosis. This surgically-mobilized segment coincides both with turbulent flow as well as with devascularization of the vasa vasorum. These processes have been associated with endothelial cell activation and a dysfunctional phenotype. Therefore investigators hypothesized that surgical techniques which minimize venous dissection may improve fistula maturation and access patency.
Accordingly, investigators developed the "Radial Artery Deviation And Reimplantation (RADAR) technique." Instead of using a traditional end-vein to side-artery anastomosis, RADAR uses an end-artery to side-vein anastomosis, additionally coupled with minimal vessel dissection. Investigators extend conventional "no touch" techniques and advocate avoidance of any venous dissection or manipulation. Investigators minimize arterial dissection as well, by dissecting the radial artery pedicle, not the artery itself.
The aim of this study is to compare the safety and efficacy of this novel technique with the traditional radial-cephalic fistula in the setting of a multicenter randomized controlled trial. Besides traditional endpoints such as patency and reintervention rates, hand blood perfusion will be assessed with objective measurements.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Nirvana SADAGHIANLOO, MD
- Phone Number: +33492033835
- Email: sadaghianloo.n@chu-nice.fr
Study Locations
-
-
-
Draguignan, France
- Polyclinique Notre Dame
-
Marseille, France
- APHM
-
Nice, France
- CHU de Nice - Service de chirurgie vasculaire
-
Ollioules, France
- Polyclinique les Fleurs
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patient referred by the nephrologist for the creation of a primary vascular access
Clinical examination of both upper limbs showing on the same limb:
- A cephalic vein at the distal third of the forearm
- Radial pulse
- Ulnar pulse
- Positive Allen test (patent palmar arches)
Preoperative arterial and venous duplex ultrasound examination of both limbs showing on the same limb :
- A patent cephalic vein, ≥2mm in diameter at the distal 1/3 of the forearm, free from stenosis, ≥15cm in length
- A patent on dominant radial artery, ≥2mm in diameter at the distal 1/3 of the forearm, free from stenosis and major calcifications
- A patent ulnar artery, free from stenosis and major calcifications
- A positive Allen's test with assessment of the retrograde flow (patent palmar aches)
- Digital pressure >50mmHg when occlusive compression is made on the radial artery and digital/brachial ratio >0.5
Exclusion Criteria:
- patient under guardianship
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: arteriovenous fistula (AVF)
Patient receiving a traditional arteriovenous fistula at the wrist (end-cephalic vein to side-radial artery)
|
|
Experimental: RADAR
Patient receiving an arteriovenous fistula at the wrist using the Radial Artery Deviation And Reimplantation technique (end-radial artery to side-cephalic vein)
|
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Primary patency rate of the access
Time Frame: at 12 months
|
at 12 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Assisted primary patency rate of the access
Time Frame: 6 & 12 months
|
6 & 12 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Serge DECLEMY, MD, Vascular surgery, Nice University Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 15-API-02
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on End-stage Renal Disease
-
Outset MedicalCompletedAcute Kidney Injury | End Stage Renal Disease (ESRD) | End Stage Renal Disease on DialysisUnited States
-
University of Illinois at ChicagoWithdrawnObesity | End-Stage Renal Disease | Renal Disease, End-Stage | Renal Failure, End-StageUnited States
-
Bioconnect Systems, IncCompletedEnd-stage Renal Disease | End-stage Kidney DiseaseUnited States
-
Xinhua Hospital, Shanghai Jiao Tong University...Changhai Hospital; Shanghai Zhongshan Hospital; RenJi Hospital; Ruijin Hospital; Shanghai... and other collaboratorsCompleted
-
Clinical Research Center for End Stage Renal Disease...Kyungpook National University Hospital; Medical Research Collaborating Center... and other collaboratorsActive, not recruitingEnd-Stage Renal DiseaseKorea, Republic of
-
Medtronic - MITGCompletedEnd-stage Renal DiseaseGermany
-
China Medical University HospitalUnknown
-
Guangdong Provincial Hospital of Traditional Chinese...Ministry of Science and Technology of the People´s Republic of ChinaUnknown
-
University of California, San FranciscoCompletedEnd-stage Renal DiseaseUnited States
-
Mark A. LumleyHenry Ford Health SystemCompleted
Clinical Trials on End-cephalic vein to side-radial artery fistula creation
-
Sunnybrook Health Sciences CentreCanadian Institutes of Health Research (CIHR)CompletedCoronary Artery DiseaseNew Zealand, Canada