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End Stage Renal DiseaseNCT03300024

Bovine Carotid Artery Biologic Graft and Expanded Polytetrafluoroethylene for Permanent Hemodialysis Access

A study testing Expanded polytetrafluoroethylene Graft and Bovine Carotid Artery Graft in people with End Stage Renal Disease and Hemolysis, run by Johns Hopkins University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The investigators propose a randomized study to compare bovine carotid artery (BCA) biologic grafts and expanded polytetrafluoroethylene grafts (ePTFE) for permanent hemodialysis access. Read more about this study

Who is it for?
Ages 18 to 90 years
What is being tested?
Expanded polytetrafluoroethylene Graft and Bovine Carotid Artery Graft
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
1 siteUnited States
Study dates
1 Feb 2015to 12 Feb 2018
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients at least 18 years of age
  • Have End Stage Renal Disease and are undergoing Arterio-Venous-Graft surgery
  • Not Eligible to receive an Arterio-Venous-Fistula
  • Provided written informed consent
  • Agreed to return for all required clinical follow up for the study

Who cannot join

  • Eligible to receive an Arterio-Venous-Fistula
  • Known allergic reaction or history of intolerance to any ePTFE or BCA components
  • Local infection at AVG placement site at the time of surgery
  • Patients with a bleeding disorder or who refuse blood transfusion
  • Patients with an active malignancy
  • Life expectancy less than 1 year
  • Pregnant women or those planning on becoming pregnant for the duration of the study

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Johns Hopkins University

    Baltimore, Maryland, 21224

Other trials in United States

About this study

Official title: A Prospective Randomized Study of Bovine Carotid Artery Biologic Graft and Expanded Polytetrafluoroethylene for Permanent Hemodialysis Access

The investigators propose a randomized study to compare bovine carotid artery (BCA) biologic grafts and expanded polytetrafluoroethylene grafts (ePTFE) for permanent hemodialysis access.

Read the detailed description

Arteriovenous grafts (AVG) remain reliable substitutes for permanent hemodialysis access in scenarios that preclude the placement of arteriovenous fistulae. There is scarcity of evidence to support the current preference of synthetic conduits over biologic grafts in clinical practice. Advances in the design of AVG's warrant contemporary comparisons between synthetic and biologic AVG options. This is especially important as biologic conduits may confer an advantage by virtue of their inherent similarity to the native human vasculature.

The overall goal of this project is to compare one and two year patency (functional, primary, primary assisted and secondary), complication rates and re-intervention rates between BCA and standard ePTFE grafts. The investigators hypothesize that vascular patient who will receive the BCA graft will have improved patency as well as lower complication and re-intervention rates compared to the standard ePTFE graft.

Being tested
Expanded polytetrafluoroethylene Graft, Bovine Carotid Artery Graft
Keywords
Hemodialysis, Arteriovenous, Graft, polytetrafluoroethylene, Bovine
Medical subject headings
Kidney Failure, Chronic, Hemolysis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Expanded polytetrafluoroethylene GraftDevice

    Also called Synthetic Graft

    Group will receive any standard ePTFE graft (control) based on the surgeons' discretion. The graft will be placed either in the arm (brachial artery to axillary vein) or forearm (brachial artery to cephalic or suitably sized vein) depending on which location works best in your particular case.

  • Bovine Carotid Artery GraftDevice

    Also called Biological Graft

    Group will receive the BCA graft (experimental).The graft will be placed either in the arm (brachial artery to axillary vein) or forearm (brachial artery to cephalic or suitably sized vein) depending on which location works best in your particular case.

Study groups in NCT03300024
Study groupRoleWhat they receive
Expanded polytetrafluoroethylene (ePTFE)Active comparatorThe ePTFE grafts used are the Flixene (Maquet-Atrium Medical, Hudson, NH), Advanta VXT (Maquet-Atrium), GORE-TEXStretch Vascular Graft For Vascular Access (W. L. Gore and Associates, Flagstaff, Ariz), or Venaflo (Bard Peripheral Vascular, Tempe, Ariz). The choice of graft used is at the surgeons' discretion. The graft it is offered in both large and small diameters, as well as thin-wall and rapidly-tapering designs for cases where arterial steal syndrome is a potential complication. A 6 mm graft featuring external supporting rings in 5 cm centered or 7 cm offset sections enables tight loop configurations and crossing the cubitus. A 4-7 mm tapered graft with 10 or 15 cm of removable rings allows for tailoring or exact placement of the ringed section.
Receives: Device: Expanded polytetrafluoroethylene Graft
Bovine carotid Artery GraftExperimentalThe bovine carotid artery biological grafts (Artegraft®; Artegraft, Inc., North Brunswick, NJ) consist of a biological fibrous matrix processed to enhance long-term patency and provide a tightly woven, cross-linked conduit that is flexible and compliant.
Receives: Device: Bovine Carotid Artery Graft

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Patients With Primary Graft Patency

    Primary patency is defined as the interval from graft placement to any intervention for stenosis with or without complete occlusion (thrombosis).

    Measured: One year after Graft Placement

  2. Percentage of Patients With Primary-Assisted Graft Patency

    Assisted primary patency is defined as the interval from graft placement to the first episode of complete occlusion.

    Measured: One year after Graft Placement

  3. Percentage of Patients With Secondary Graft Patency

    Secondary patency is defined as the interval from graft placement to graft failure.

    Measured: One year after Graft Placement

  4. Percentage of Patients With Functional Patency

    Functional patency represents the interval from the first time the graft is used for hemodialysis to any qualifying event (stenosis, thrombosis, graft failure)

    Measured: One year after Graft Placement

  5. Percentage of Patients With Primary Graft Patency

    Primary patency is defined as the interval from graft placement to any intervention for stenosis with or without complete occlusion (thrombosis).

    Measured: Two years after Graft Placement

  6. Percentage of Patients With Primary-Assisted Graft Patency

    Assisted primary patency is defined as the interval from graft placement to the first episode of complete occlusion.

    Measured: Two years after Graft Placement

  7. Percentage of Patients With Secondary Graft Patency

    Secondary patency is defined as the interval from graft placement to graft failure.

    Measured: Two years after Graft Placement

  8. Percentage of Patients With Functional Patency

    Functional patency represents the interval from the first time the graft is used for hemodialysis to any qualifying event (stenosis, thrombosis, graft failure)

    Measured: Two years after Graft Placement

Secondary outcomes (16)
  1. Incidence of Pseudoaneurysms Formation at the Access Site

    Measured: At 6 months after Graft Placement

  2. Incidence of Pseudoaneurysms Formation at the Access Site

    Measured: At 12 months after Graft Placement

  3. Incidence of Pseudoaneurysms Formation at the Access Site

    Measured: At 18 months after Graft Placement

  4. Incidence of Pseudoaneurysms Formation at the Access Site

    Measured: At 24 months after Graft Placement

  5. Percentage of Patients With Surgical Site Infection

    The presence of erythema or purulent drainage at the surgical incision and need for intravenous antibiotics or surgical intervention.

    Measured: At 6 months after Graft Placement

  6. Percentage of Patients With Surgical Site Infection

    The presence of erythema or purulent drainage at the surgical incision and need for intravenous antibiotics or surgical intervention.

    Measured: At 12 months after Graft Placement

  7. Percentage of Patients With Surgical Site Infection

    The presence of erythema or purulent drainage at the surgical incision and need for intravenous antibiotics or surgical intervention.

    Measured: At 18 months after Graft Placement

  8. Percentage of Patients With Surgical Site Infection

    The presence of erythema or purulent drainage at the surgical incision and need for intravenous antibiotics or surgical intervention.

    Measured: At 24 months after Graft Placement

  9. Steal Syndrome

    Steal syndrome will be staged per standard as follows: Stage I: pale/blue and/or cold hand without pain; Stage II: Pain during exercise and/or hemodialysis; Stage III: Rest pain; Stage IV: Ulcers/necrosis/gangrene. Accordingly, surgical intervention will be carried out for patients with stage III or IV steal.

    Measured: At 6 months after Graft Placement

  10. Steal Syndrome

    Steal syndrome will be staged per standard as follows: Stage I: pale/blue and/or cold hand without pain; Stage II: Pain during exercise and/or hemodialysis; Stage III: Rest pain; Stage IV: Ulcers/necrosis/gangrene. Accordingly, surgical intervention will be carried out for patients with stage III or IV steal.

    Measured: At 12 months after Graft Placement

  11. Steal Syndrome

    Steal syndrome will be staged per standard as follows: Stage I: pale/blue and/or cold hand without pain; Stage II: Pain during exercise and/or hemodialysis; Stage III: Rest pain; Stage IV: Ulcers/necrosis/gangrene. Accordingly, surgical intervention will be carried out for patients with stage III or IV steal.

    Measured: At 18 months after Graft Placement

  12. Steal Syndrome

    Steal syndrome will be staged per standard as follows: Stage I: pale/blue and/or cold hand without pain; Stage II: Pain during exercise and/or hemodialysis; Stage III: Rest pain; Stage IV: Ulcers/necrosis/gangrene. Accordingly, surgical intervention will be carried out for patients with stage III or IV steal.

    Measured: At 24 months after Graft Placement

  13. Percentage of Patients Requiring Revisional Procedures of the Arteriovenous Graft

    At hemodialysis, the grafts will be accessed with 15 or 17 gauge needles inserted at any angle between 25-30 degrees (the same method used for a native arterio-venous fistula). If by physical examination the graft is thrombosed, then the patient will immediately be referred for endovascular thrombectomy and revision. If the graft is patent, but problematic, the patient will be referred for an urgent fistulogram and endovascular reintervention

    Measured: At 6 months after Graft Placement

  14. Percentage of Patients Requiring Revisional Procedures of the Arteriovenous Graft

    At hemodialysis, the grafts will be accessed with 15 or 17 gauge needles inserted at any angle between 25-30 degrees (the same method used for a native arterio-venous fistula). If by physical examination the graft is thrombosed, then the patient will immediately be referred for endovascular thrombectomy and revision. If the graft is patent, but problematic, the patient will be referred for an urgent fistulogram and endovascular reintervention

    Measured: At 12 months after Graft Placement

  15. Percentage of Patients Requiring Revisional Procedures of the Arteriovenous Graft

    At hemodialysis, the grafts will be accessed with 15 or 17 gauge needles inserted at any angle between 25-30 degrees (the same method used for a native arterio-venous fistula). If by physical examination the graft is thrombosed, then the patient will immediately be referred for endovascular thrombectomy and revision. If the graft is patent, but problematic, the patient will be referred for an urgent fistulogram and endovascular reintervention

    Measured: At 18 months after Graft Placement

  16. Percentage of Patients Requiring Revisional Procedures of the Arteriovenous Graft

    At hemodialysis, the grafts will be accessed with 15 or 17 gauge needles inserted at any angle between 25-30 degrees (the same method used for a native arterio-venous fistula). If by physical examination the graft is thrombosed, then the patient will immediately be referred for endovascular thrombectomy and revision. If the graft is patent, but problematic, the patient will be referred for an urgent fistulogram and endovascular reintervention

    Measured: At 24 months after Graft Placement

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Oct 2017
  2. Study start1 Feb 2015
  3. Primary completion12 Feb 2018
  4. Study completion12 Feb 2018

Why it stopped: Funding ended

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients will undergo surgery as per standard of care and receive the randomized graft in compliance to National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for Arteriovenous graft creation. Surgeries will be elective in nature. The grafts will be placed either in the arm (brachial artery-axillary vein) or forearm (brachial artery to cephalic or suitably sized vein) based on anatomic suitability
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
10 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03300024
Sponsor's protocol ID
IRB00069002
Status last verified
May 2019
First submitted
18 Sep 2017
Last updated
21 May 2019
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No: Only key study personnel will be responsible for entering and tracking information. At the end of the study period, study coordinators and research fellows will have access to the final trial dataset and will analyse the data. The final results will be communicated to the PI and co-PI's, the sponsors and participants and will be later published in a peer-reviewed scientific journal.

Publications

  • Dakour Aridi H, Arhuidese I, Scudder M, Reifsnyder T, Malas MB. A prospective randomized study of bovine carotid artery biologic graft and expanded polytetrafluoroethylene for permanent hemodialysis access. J Vasc Surg. 2018 May;67(5):1606-1612.e4. doi: 10.1016/j.jvs.2017.12.058. Epub 2018 Mar 19.

    PubMed 29567027

Questions about this trial

What is this clinical trial studying?

A study testing Expanded polytetrafluoroethylene Graft and Bovine Carotid Artery Graft in people with End Stage Renal Disease and Hemolysis, run by Johns Hopkins University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 21 May 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 May 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Patients With Primary Graft Patency (time frame: One year after Graft Placement). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03300024, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 May 2019.

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