- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04141852
VasQ and Hemodynamic Conditions in AVFs (RESHAPE)
Arterovenous Fistula Surgery With the VasQ Support Device: The Effects on Hemodynamic Conditions - Pilot Study
End-stage renal disease (ESRD) is a growing global health problem, strictly connected with progressive ageing population and longer survival of patients living on renal replacement therapy. The majority of ESRD patients is on hemodialysis (HD) treatment. A successful HD procedure requires a functional vascular access (VA) to provide safe and long-lasting way to connect patient circulation to the artificial kidney. To date, VA dysfunction is the major cause of morbidity and hospitalisation in HD patients, and the major limitation of HD treatment. The current recommendation for VA is the native artero-venous fistula (AVF), surgically created in the forearm, but is still affected by high non-maturation and early failure rates. The most common cause of AVF early-failure is vascular stenosis due to neointimal hyperplasia (NH). Despite the exact mechanisms underlying stenosis development remain tentative, there is general consensus that hemodynamic conditions play a key role in the formation of NH. Previous computational fluid dynamics (CFD) investigations inside patient-specific AVF models conducted by our group revealed transitional laminar-to-turbulent flow in the juxta-anastomotic vein.
Various vascular access devices have been designed to incorporate features to regularize the hemodynamics and favour spiral flow development in the venous segment of the AVF. The VasQ external support device (Laminate Medical Technologies, Israel) is a novel Nitinol implant, externally surrounding and supporting the vein and "hugging" the artery near the junction site, without being in contact with the blood flow.
VasQ attempts at constraining and shaping geometrical parameters of the AVF, as well as reinforcing the vulnerable perianastomotic vein against high pressure, wall tension and flow levels. A prospective single-centre study demonstrated the safety of the VasQ external support device, but the effect of its use on hemodynamic conditions and the advantages in terms of flow regularization in patient-specific AVFs still need to be investigated.
A detailed analysis of the local blood flow field in patient-specific AVFs can be obtained coupling non contrast-enhanced MRI (NCE-MRI) and high-resolution CFD simulations, using a NCE-MRI protocol recently optimized by our group. Our MRI sequence has the advantage of providing high-quality images in a short acquisition time of 5-10 minutes compared to other MRI protocols that require more than 45 minutes for a single acquisition. Combined with high-resolution CFD, our MRI-to-CFD pipeline allowed us to characterize morphological and hemodynamic changes in the AVF of one patient at two timepoints, immediately after AVF surgery and at AVF maturation. Therefore, it seems to be a promising approach to perform morphological and hemodynamic analysis also in AVF created using the VasQ device and can be used to elucidate the effects of VasQ device on hemodynamic conditions, as compared to hemodynamic conditions present in AVFs created using conventional surgery without the use of any device.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
BG
-
Bergamo, BG, Italy, 24100
- ASST - Papa Giovanni XXIII - U.O. Nefrologia e Dialisi/ Mario Negri Institute for Pharmacological Research - Clinical Research Center for Rare Diseases Aldo e Cele Daccò
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age > 18 years and < 75 years
- Patients that entered the pre-dialysis program because of ESRD
- Patients in need of a new VA for HD treatment
- Treatment of first choice is creation of a distal autogenous AVF
- Written informed consent
Exclusion Criteria:
- Contraindication for creating an autogenous AVF
- Life expectancy less than 1 year
- Prior VA, central venous stenosis or obstructions in the arm selected for AVF surgery
- Patient not suitable for MRI examination (ferro-magnetic prosthesis, pacemaker, aneurysm clips, obesity, spastic paralysis, severe claustrophobia or other contraindications or exclusions interfering with MRI)
- Unusual anatomy or vessel dimensions (observed on pre-operative US or intraoperatively) and which preclude adequate fit of the VasQ.
- Depth of vein greater than 8 mm (on ultrasound) on side of surgery
- Known coagulation disorder
- Known allergy to nitinol
- Patients expected to undergo kidney transplant within 12 months of enrollment
- Females who are pregnant or planning to become pregnant during the study
- Inability to give consent and/or comply with the study follow up schedule
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Device Feasibility
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: AVF surgery with device
|
The VasQ external support device (Laminate Medical Technologies, Israel) is a novel Nitinol implant, externally surrounding and supporting the vein and "hugging" the artery near the junction site, without being in contact with the blood flow.
|
No Intervention: AVF surgery conventional
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Wall shear stress in AVFs.
Time Frame: Changes from 3 days after surgery and 40 days after surgery.
|
Hemodynamic parameter (wall shear stress) obtained by combining MRI acquisition/ processing and computational fluid dynamics.
|
Changes from 3 days after surgery and 40 days after surgery.
|
Oscillatory shear index in AVFs.
Time Frame: Changes from 3 days after surgery and 40 days after surgery.
|
Hemodynamic parameter (oscillatory shear index) obtained by combining MRI acquisition/ processing and computational fluid dynamics.
|
Changes from 3 days after surgery and 40 days after surgery.
|
Collaborators and Investigators
Collaborators
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 (Actual)
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
- RESHAPE
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 Renal Insufficiency, Chronic
-
American Academy of Family PhysiciansUniversity of Colorado, Denver; National Institute of Diabetes and Digestive... and other collaboratorsCompletedChronic Kidney Disease | Chronic Renal Insufficiency | Chronic Kidney Insufficiency | Chronic Renal Diseases | Kidney Insufficiency, ChronicUnited States
-
University of WashingtonJohns Hopkins University; National Institute of Diabetes and Digestive and... and other collaboratorsRecruitingChronic Kidney Diseases | Acute Renal Failure | Acute Renal Injury | Acute Kidney Failure | Chronic Renal Insufficiency | Kidney Failure, Acute | Renal Insufficiency, Acute | Acute Renal Insufficiency | Acute Kidney Insufficiency | Renal Failure, Acute | Chronic Kidney Insufficiency | Chronic Renal Diseases | Kidney... and other conditionsUnited States
-
University of the State of Santa CatarinaUnknownKidney Diseases | Chronic Kidney Diseases | Hemodialysis | Chronic Renal Insufficiency | Renal Dialysis | Chronic Kidney Insufficiency | Chronic Renal DiseasesBrazil
-
University of PennsylvaniaTeleflex; Arrow InternationalCompletedRenal Failure Chronic Requiring Hemodialysis | Chronic Renal InsufficiencyUnited States
-
Hospices Civils de LyonCompletedChronic Renal Insufficiency | Cardiac TransplantationFrance
-
CHU de ReimsUnknownChronic Renal InsufficiencyFrance
-
Southern Medical University, ChinaTerminatedChronic Kidney Failure
-
Centre Hospitalier Universitaire de NiceTerminatedAged | Chronic Renal Insufficiency | Chronic Kidney FailureFrance
-
Azienda Sanitaria ASL Avellino 2UnknownChronic Renal InsufficiencyItaly
-
Assistance Publique Hopitaux De MarseilleCompletedChronic Renal InsufficiencyFrance
Clinical Trials on Implantation of VasQ device
-
Cutting Edge SASRecruitingCataract | Surgery | IOLFrance
-
Federal State Budgetary Institution, V. A. Almazov...TerminatedHeart FailureRussian Federation
-
Cutting Edge SAStargomedGmbHRecruitingCataract | Lens OpacitiesSingapore, Spain, Czechia, Germany, Philippines, Austria
-
Cutting Edge SAStargomedGmbHRecruitingCataract | Lens OpacitiesSpain, Czechia
-
Assistance Publique - Hôpitaux de ParisComphya SANot yet recruitingErectile Dysfunction | Spinal Cord InjuriesFrance
-
University of Campania "Luigi Vanvitelli"Recruiting
-
Jocelyne BlochRecruitingSpinal Cord InjuriesSwitzerland
-
Jocelyne BlochEcole Polytechnique Fédérale de LausanneRecruitingDeep Brain Stimulation | Neuro: Spinal Cord InjurySwitzerland
-
Abbott Medical DevicesCompleted
-
S. Andrea HospitalFederico II University; Policlinico Hospital; Azienda Ospedaliera Bolognini di... and other collaboratorsRecruiting