Aortoiliac Occlusive DiseaseNCT04458714
Carbon Dioxide Versus Iodine Contrast for Endovascular Revascularization of Aortoiliac Occlusive Disease
A study testing Aortoiliac angioplasty in people with Aortoiliac Occlusive Disease, run by Zagazig University.
Trial summary
From July 2015 to July 2018, 64 patients with aortoiliac occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide (CO2) were randomized into the carbon dioxide CO2 group(32) or iodine contrast medium(ICM) group(32) were subjected to… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Aortoiliac Occlusive Disease
- What is being tested?
- Aortoiliac angioplasty
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 64 participants
- Where
- No sites listed yet
- Study dates
- 1 Jul 2015to 15 Jan 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with aortoiliac arteries atherosclerotic disease (with arterial atherosclerotic disease classified as Trans-Atlantic Inter-Society Consensus (TASC) A, B and C, (classified by CT angiography)
- Patients with good distal runoff
- Patients suitable for either types of contrast ICM or CO2 (No history of allergy to contrast and normal kidney functions)
Who cannot join
- Patients with TASC D aortoiliac lesions
- Patients requiring femoral endartectomy
- Patient s with significant multilevel distal disease
- Patients suffering from severe chronic obstructive lung disease, chronic kidney failure, heart failure, or pregnancy.
- Patients younger than 18 years
About this study
Official title: Carbon Dioxide Versus Iodine Contrast Medium for Endovascular Revascularization of Aortoiliac Occlusive Disease: A Two Center Randomized Controlled Trial
From July 2015 to July 2018, 64 patients with aortoiliac occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide (CO2) were randomized into the carbon dioxide CO2 group(32) or iodine contrast medium(ICM) group(32) were subjected to aortoiliac angioplasty. The primary outcome was the quality of image as the sole contrast agent used in interventions. The secondary outcomes were technical success rate and the safety of procedure.
Read the detailed description
Sampling The sample size was calculated by the intuitional review board statistician using open epi based on the RCT done by Mendes et al. Power of study as set at 80% and confidence interval set at 95%. The sample size was calculated to be 64 cases, 32 in each group.
Randomization All patients who qualified for the inclusion and exclusion criteria were offered to participate in the trial after explaining all the details involved with the potential benefits and risks of both contrast mediums. Patients who agreed were asked to sign an informed consent. After patient data input was done, randomization was computer generated in the vascular surgery department in Zagazig university hospitals. Computer generated random numbers were created with the use of randomly permuted blocks with two block sizes; after which they were secured in consecutive numbered envelopes and group allocation was independent of time and person delivering the treatment. Single blinding was used to recruit the patients. The patients were randomized into the following two arms: a CO2 group (treatment arm) and an ICM group (control arm) according to the contrast medium selected for the intervention. Group I included 32 patients who were randomized for using CO2 as the contrast medium. Group II: involved 32 patients who were randomized for using iodine contrast medium (ICM).
Postoperative assessment and follow-up The endovascular equipment used in each intervention and the volumes of contrast used were accurately documented for analysis. Immediately after the operation all patients in both arms received intravenous fluids pre and post intervention following a local guideline for renal protection.¬ Patients were discharged the next day and outpatient renal functions were repeated 3 days post procedure, 1 week and 1 month. We analyzed creatinine levels between the two groups during the pre- and post-operative periods. Any elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl is defined as contrast induced nephropathy (CIN). Patients were followed up for 1 year. One patient from the CO2 group decided to withdraw from the trial during the follow up period and was excluded from the follow up analysis.
Imaging from all cases were analyzed on conclusion of the study. The images were reviewed by two independent observers (radiologists with > 5 years of experience in performing endovascular procedures) blinded to treatment arm. Image quality was assessed using Likert rating scale ranging from 1 (very poor) to 5 (very good) for each image.18 A score of 1 was defined as poor quality with loss of delineation of the vessel. A score of 2 was considered below average with poor delineation of the vessel, a score of 3 is for average quality image and medium delineation of the vessel, a score of 4 was considered good quality with clear delineation of the vessel and a score of 5 was considered very good quality with very clear delineation of the vessel.
- Conditions
- Aortoiliac Occlusive Disease
- Being tested
- Aortoiliac angioplasty
- Keywords
- CO2 angiography, angioplasty, aortoiliac occlusive disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Aortoiliac angioplastyProcedure or surgery
In the CO2 arm we used manual injection of CO2 from a medicinal CO2 cylinder connected to a particle filter. Under water aspiration was used to prevent air contamination. Using a twenty mls syringe the required amount of CO2was aspirated using a three way tap and was followed my aspirating 3mls of saline to provide a fluid barrier. In the ICM arm the injection of contrast was done using 10-ml syringes with 5 mls of iodinated contrast media and 5 mls of saline solution per injection. The ICM used in all cases was Omnipaque 300 (Iohexol), a nonionic low osmolar contrast commonly in use in both hospitals.
| Study group | Role | What they receive |
|---|---|---|
| CO2 group (treatment arm) | Active comparator | This arm included 32 patients who were randomized for using CO2 as the contrast medium for aortoiliac angiolplasty. Receives: Procedure: Aortoiliac angioplasty |
| ICM group (control arm) | Active comparator | This arm involved 32 patients who were randomized for using iodine contrast medium (ICM) for aortoiliac angiolplasty. Receives: Procedure: Aortoiliac angioplasty |
What is being measured
The primary outcome is the main question the study is designed to answer.
quality of image as the sole contrast agent to perform the needed interventions: Likert rating scale
Imaging from all cases were analyzed on conclusion of the study. The images were reviewed by two independent observers (radiologists with > 5 years of experience in performing endovascular procedures) blinded to treatment arm. Image quality was assessed using Likert rating scale ranging from 1 (very poor) to 5 (very good) for each image.
Measured: on conclusion of patient recruitment , image quality was aseessed within 12 weeks
Secondary outcomes (2)
technical success rate
surgical results with completion of the intended procedure.
Measured: immediate post operative
Incidence of Procedure-related complications .
defined as the freedom from procedural complications (Procedure-related complications were the incidence of cardiac death, myocardial infarction, stroke, major amputation, non-occlusive mesenteric ischemia, extended hospitalization (> 24 hours) as a consequence of CO2-guided treatment, hematomas, pseudo-aneurysms, perforations, contrast induced nephropathy (CIN), target lesion revascularization and postoperative death within 3 months of surgery,)
Measured: 1year follow up
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Jul 2020
- Study start1 Jul 2015
- Primary completion1 Jul 2019
- Study completion15 Jan 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Aortoiliac Occlusive DiseaseStudies of the same condition, open and under way.
- More trials run by Zagazig UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 64 participants (actual)
Sponsor and investigators
- Lead sponsor
- Zagazig University
- Sponsor type
- Other government
- Responsible party
- Principal investigator, Amro Elboushi, Zagazig University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04458714
- Sponsor's protocol ID
- zu-irb#6036/16-3-2015
- Status last verified
- Jul 2020
- First submitted
- 30 Jun 2020
- Last updated
- 7 Jul 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
de Almeida Mendes C, de Arruda Martins A, Teivelis MP, Kuzniec S, Nishinari K, Krutman M, Halpern H, Wolosker N. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease. Ann Vasc Surg. 2014 Aug;28(6):1473-8. doi: 10.1016/j.avsg.2014.03.021. Epub 2014 Apr 3.
PubMed 24704050Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R, Higashimori A, Yokoi Y; CO2 Angiography Registry Investigators. Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv. 2015 Apr;85(5):870-7. doi: 10.1002/ccd.25722. Epub 2014 Nov 21.
PubMed 25380326Sharafuddin MJ, Marjan AE. Current status of carbon dioxide angiography. J Vasc Surg. 2017 Aug;66(2):618-637. doi: 10.1016/j.jvs.2017.03.446.
PubMed 28735955
Study at a glance
From the registry record, last updated by the sponsor on 7 Jul 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Carbon Dioxide Versus Iodine Contrast Medium for Endovascular Revascularization of Aortoiliac Occlusive Disease: A Two Center Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT04458714
- Acronym / sponsor ID
- zu-irb#6036/16-3-2015
- Conditions
- Aortoiliac Occlusive Disease
- Keywords
- CO2 angiography, angioplasty, aortoiliac occlusive disease
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 64 participants (actual)
- Lead sponsor
- Zagazig UniversityOther government
- Study start
- 1 Jul 2015 (actual)
- Primary completion
- 1 Jul 2019 (actual)
- Study completion
- 15 Jan 2020 (actual)
- First posted
- 7 Jul 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
From July 2015 to July 2018, 64 patients with aortoiliac occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide (CO2) were randomized into the carbon dioxide CO2 group(32) or iodine contrast medium(ICM) group(32) were subjected to aortoiliac angioplasty. The primary outcome was the quality of image as the sole contrast agent used in interventions. The secondary outcomes were technical success rate and the safety of procedure.
Detailed description
Sampling The sample size was calculated by the intuitional review board statistician using open epi based on the RCT done by Mendes et al. Power of study as set at 80% and confidence interval set at 95%. The sample size was calculated to be 64 cases, 32 in each group.
Randomization All patients who qualified for the inclusion and exclusion criteria were offered to participate in the trial after explaining all the details involved with the potential benefits and risks of both contrast mediums. Patients who agreed were asked to sign an informed consent. After patient data input was done, randomization was computer generated in the vascular surgery department in Zagazig university hospitals. Computer generated random numbers were created with the use of randomly permuted blocks with two block sizes; after which they were secured in consecutive numbered envelopes and group allocation was independent of time and person delivering the treatment. Single blinding was used to recruit the patients. The patients were randomized into the following two arms: a CO2 group (treatment arm) and an ICM group (control arm) according to the contrast medium selected for the intervention. Group I included 32 patients who were randomized for using CO2 as the contrast medium. Group II: involved 32 patients who were randomized for using iodine contrast medium (ICM).
Postoperative assessment and follow-up The endovascular equipment used in each intervention and the volumes of contrast used were accurately documented for analysis. Immediately after the operation all patients in both arms received intravenous fluids pre and post intervention following a local guideline for renal protection.¬ Patients were discharged the next day and outpatient renal functions were repeated 3 days post procedure, 1 week and 1 month. We analyzed creatinine levels between the two groups during the pre- and post-operative periods. Any elevation of serum creatinine (Scr) of more than 25% or ≥0.5 mg/dl is defined as contrast induced nephropathy (CIN). Patients were followed up for 1 year. One patient from the CO2 group decided to withdraw from the trial during the follow up period and was excluded from the follow up analysis.
Imaging from all cases were analyzed on conclusion of the study. The images were reviewed by two independent observers (radiologists with > 5 years of experience in performing endovascular procedures) blinded to treatment arm. Image quality was assessed using Likert rating scale ranging from 1 (very poor) to 5 (very good) for each image.18 A score of 1 was defined as poor quality with loss of delineation of the vessel. A score of 2 was considered below average with poor delineation of the vessel, a score of 3 is for average quality image and medium delineation of the vessel, a score of 4 was considered good quality with clear delineation of the vessel and a score of 5 was considered very good quality with very clear delineation of the vessel.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| CO2 group (treatment arm) | Active comparator | Procedure: Aortoiliac angioplastyThis arm included 32 patients who were randomized for using CO2 as the contrast medium for aortoiliac angiolplasty. |
| ICM group (control arm) | Active comparator | Procedure: Aortoiliac angioplastyThis arm involved 32 patients who were randomized for using iodine contrast medium (ICM) for aortoiliac angiolplasty. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Patients with aortoiliac arteries atherosclerotic disease (with arterial atherosclerotic disease classified as Trans-Atlantic Inter-Society Consensus (TASC) A, B and C, (classified by CT angiography)
- Patients with good distal runoff
- Patients suitable for either types of contrast ICM or CO2 (No history of allergy to contrast and normal kidney functions)
Key exclusion criteria (5 listed)
- Patients with TASC D aortoiliac lesions
- Patients requiring femoral endartectomy
- Patient s with significant multilevel distal disease
- Patients suffering from severe chronic obstructive lung disease, chronic kidney failure, heart failure, or pregnancy.
- Patients younger than 18 years
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Aortoiliac angioplastyIn the CO2 arm we used manual injection of CO2 from a medicinal CO2 cylinder connected to a particle filter. Under water aspiration was used to prevent air contamination. Using a twenty mls syringe the required amount of CO2was aspirated using a three way tap and was followed my aspirating 3mls of saline to provide a fluid barrier. In the ICM arm the injection of contrast was done using 10-ml syringes with 5 mls of iodinated contrast media and 5 mls of saline solution per injection. The ICM used in all cases was Omnipaque 300 (Iohexol), a nonionic low osmolar contrast commonly in use in both hospitals. | Procedure or surgery | CO2 group (treatment arm), ICM group (control arm) |
Primary outcome
quality of image as the sole contrast agent to perform the needed interventions: Likert rating scale
Time frame: on conclusion of patient recruitment , image quality was aseessed within 12 weeks
Imaging from all cases were analyzed on conclusion of the study. The images were reviewed by two independent observers (radiologists with > 5 years of experience in performing endovascular procedures) blinded to treatment arm. Image quality was assessed using Likert rating scale ranging from 1 (very poor) to 5 (very good) for each image.
2 secondary outcomes
technical success rate
Time frame: immediate post operative
Incidence of Procedure-related complications .
Time frame: 1year follow up
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Jul 2020.
- Background: PubMed 24704050de Almeida Mendes C, de Arruda Martins A, Teivelis MP, Kuzniec S, Nishinari K, Krutman M, Halpern H, Wolosker N. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease. Ann Vasc Surg. 2014 Aug;28(6):1473-8. doi: 10.1016/j.avsg.2014.03.021. Epub 2014 Apr 3.
- Background: PubMed 25380326Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R, Higashimori A, Yokoi Y; CO2 Angiography Registry Investigators. Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv. 2015 Apr;85(5):870-7. doi: 10.1002/ccd.25722. Epub 2014 Nov 21.
- Background: PubMed 28735955Sharafuddin MJ, Marjan AE. Current status of carbon dioxide angiography. J Vasc Surg. 2017 Aug;66(2):618-637. doi: 10.1016/j.jvs.2017.03.446.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing Aortoiliac angioplasty in people with Aortoiliac Occlusive Disease, run by Zagazig University.
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 3 inclusion and 5 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: finished, as of the sponsor's last update on 7 Jul 2020. Status can change between updates, so confirm with the study contact before making plans.
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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
quality of image as the sole contrast agent to perform the needed interventions: Likert rating scale (time frame: on conclusion of patient recruitment , image quality was aseessed within 12 weeks). 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 NCT04458714, which also lists 3 linked publications.
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 7 Jul 2020.