Polytetrafluoroethylen (PTFE) Vascular Prostheses With Heparin Bonded Luminal Surfaces vs Crude ePTFE (REPLACE)
Primary Purpose
Ischemia Lesions
Status
Active
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
revascularization
Propaten®
Crude PTFE
Sponsored by
About this trial
This is an interventional other trial for Ischemia Lesions focused on measuring vascular prostheses, heparin, ischemia lesions, vascular, critical limb ischemia lesions
Eligibility Criteria
Inclusion Criteria:
- Patient ≥18 years
- Patient presented critical limb ischemia (Rutherford classification: 4-6)
- Indication of below the knee bypass with an artificial graft
- Absence of an suitable autologous vein
- Patient is affiliated to the Social Security or equivalent system
- Patient has been informed of the nature of the study, agrees to its provisions and has signed the informed consent form prior to any study related procedure
- Patient agrees to undergo all protocol required follow-up examinations and requirements at the investigational site
Exclusion Criteria:
- No atheromatous disease
- Female of child bearing potential
- Patient has a history of coagulopathy or will refuse blood transfusions
- Patient is receiving or scheduled to receive anticancer therapy for malignancy within 1 year prior to or after the procedure
- Severe concomitant disease with life expectation < one year
- Known allergy to heparin
- Indication for ipsilateral major amputation
- Patient is not able to give informed consent
- Patient is currently participating in an investigational drug or device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints Note: Trials requiring extended follow-up for products that were investigational, but have become commercially suitable since then, are not considered investigational trials
- In the Investigator's opinion patient has (a) co-morbid condition(s) that could limit the patient's ability to participate in the study, compliance with follow-up requirements or impact the scientific integrity of the study
Sites / Locations
- Angers University Hospital
- Besançon University Hospital
- Bordeaux University Hospital - Hôpital Pellegrin
- Ambroise Paré university Hospital
- Brest University Hospital
- Clermont-Ferrand University Hospital
- Dijon University Hospital
- Lille University Hospital
- Lyon University Hospital - Hopital Edouard Herriot
- Timone hospital
- Nancy University Hospital
- Nantes University Hospital
- Hopital Pasteur
- Saint Joseph Hospital
- Hôpital Européen Georges Pompidou
- Bichat Hospital
- Poitiers University Hospital
- Reims university Hospital
- Saint Etienne University Hospital
- Nouvel Hopital Civil
- Valenciennes University Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Revascularization by (Propaten)®
Revascularization by Crude PTFE
Arm Description
Revascularization by PTFE with heparin bonded luminal surface (Propaten)®
Outcomes
Primary Outcome Measures
Primary patency at 1 year:
It was defined as a patent graft without any intervention to open up or prevent a graft occlusion. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Secondary Outcome Measures
Technical success defined as a patent bypass without stenosis of the proximal and the distal anastomoses.
Stenosis was defined as >30% diameter stenosis noted on intraoperative arteriography.
Perioperative complications
defined as any general complications or local complications that caused or prolonged hospitalization and/or re-intervention, lymphorrhea of more than 3-days and post-operative paresthesia that required drugs. The general complications included death from any cause, MACE. Local complications included MALE, hematoma, active bleeding, local infection, thrombosis, delayed wound healing and false aneurysm
Primary sustained clinical improvement
defined as a wound healing and rest pain resolution for patients in CLI, without the need for repeated graft it self or anastomoses in surviving patients.
Secondary sustained clinical improvement
defined as primary sustained clinical improvement including the need for repeated graft it self or anastomoses.
Primary patency
defined as a patent graft without any intervention to open up or prevent a graft occlusion. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Major adverse cardiovascular events
defined as MACEs including all cardiac deaths, Q wave infarction, stroke
MALE (Major Adverse Limb Event)-free survival rates in subjects with CLI randomized to Propaten vs. crude ePTFE.
MALE is defined as above-ankle amputation of the index limb or major reintervention (new bypass graft, jump/interposition graft revision, or thrombectomy/ thrombolysis).
Limb salvage defined as freedom from above-ankle amputation of the index limb
Secondary patency
secondary patency in which graft patency is lost (occlusion) and restored by thrombectomy, thrombolysis, or transluminal angioplasty, and/or any problems with the graft itself or one of its anastomoses require revision or reconstruction. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Assisted patency
: Assisted patency at 1, 12 and 24 months post procedure, in which patency was never lost but maintained by prophylactic intervention. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Death
Death (all cause)
Ankle brachial index
Post-operative assessment (clinical, morphological, hemodynamic criteria)
Quality of life at inclusion, .
assessed according the EQ-5D-3L questionnaire
Cost utility analysis (CUA)
In CUA, the outcomes of an intervention are evaluated in terms of Quality-Adjusted Life-Years (QALYs). QALYs are a numerical index that encompasses both the length of life and the health-related quality-of-life.
cost-effectiveness analysis (CEA)
The Measure of outcome for CEA will be the number of Life Years Gained (LYG) at 2 years
Full Information
NCT ID
NCT03430076
First Posted
January 16, 2018
Last Updated
November 3, 2022
Sponsor
Nantes University Hospital
Collaborators
W.L.Gore & Associates
1. Study Identification
Unique Protocol Identification Number
NCT03430076
Brief Title
Polytetrafluoroethylen (PTFE) Vascular Prostheses With Heparin Bonded Luminal Surfaces vs Crude ePTFE
Acronym
REPLACE
Official Title
Polytetrafluoroethylen (PTFE) Vascular Prostheses With Heparin Bonded Luminal Surfaces vs Crude ePTFE in the Treatment of Critical Limb Ischemia Lesions in the Absence of a Suitable Autologous Vein
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 13, 2018 (Actual)
Primary Completion Date
January 30, 2023 (Anticipated)
Study Completion Date
January 30, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nantes University Hospital
Collaborators
W.L.Gore & Associates
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Open repair could be recommended in a first line of treatment to revascularize critical limb ischemia patients or performed in a second line of treatment in case of failure of endovascular repair. A good quality vein is one of the main factors that influence the clinical success of open revascularization for below-knee popliteal. In the absence of an suitable autologous vein, prosthesis such as polytetrafluoroethylen (PTFE) graft could be an option but demonstrated worse clinical and morphological results compared to autologous greater saphenous vein. Consequently, there is still a room for improvement in CLI patients in the absence of an suitable autologous vein in whom endovascular repair failed.
Recently, PTFE with heparin-bound to the luminal surface (Hb-PTFE) significantly reduced the overall risk of primary graft failure by 37%, in particular, risk reduction was 50% in femoropopliteal bypass cases in cases with critical ischemia (58% Primary patency for crude ePTFE versus 80% primary patency for PROPATEN at 1 year follow-up) (Lindholt, et. al. 2011).
Additionally, a weighted average from the literature suggests a 76% primary patency for below knee bypasses performed with PROPATEN at one year follow-up, whereas a published meta-analysis suggests a 59% primary patency for below knee crude ePTFE at one year follow-up. At two year follow-up using the same approach, the average primary patency for PROPATEN was 67% versus 43% for standard ePTFE.
The aim of this study is to assess PTFE with heparin-bound to the luminal surface as an alternative to crude PTFE in absence of good venous conduit in patients with CLI.
Detailed Description
Patient inclusion in this study will be proposed 60 to 1-days period preceding the surgical procedure. The patient will be randomized in the crude PTFE or in the Propaten groups. Regarding the intervention, the technique used during the therapeutic procedure shall be left to the operator's discretion, except the type of the graft. Demographic, intraoperative and postoperative data will be collected prospectively. Patient will be assessed and followed up according a current care. The cost difference between both groups will be identified.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ischemia Lesions
Keywords
vascular prostheses, heparin, ischemia lesions, vascular, critical limb ischemia lesions
7. Study Design
Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
228 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Revascularization by (Propaten)®
Arm Type
Experimental
Arm Description
Revascularization by PTFE with heparin bonded luminal surface (Propaten)®
Arm Title
Revascularization by Crude PTFE
Arm Type
Active Comparator
Intervention Type
Procedure
Intervention Name(s)
revascularization
Intervention Description
open revascularization for below-knee popliteal in the absence of an suitable autologous vein with PTFE.
Intervention Type
Device
Intervention Name(s)
Propaten®
Intervention Description
Propaten®
Intervention Type
Device
Intervention Name(s)
Crude PTFE
Intervention Description
Crude PTFE
Primary Outcome Measure Information:
Title
Primary patency at 1 year:
Description
It was defined as a patent graft without any intervention to open up or prevent a graft occlusion. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Technical success defined as a patent bypass without stenosis of the proximal and the distal anastomoses.
Description
Stenosis was defined as >30% diameter stenosis noted on intraoperative arteriography.
Time Frame
2 years
Title
Perioperative complications
Description
defined as any general complications or local complications that caused or prolonged hospitalization and/or re-intervention, lymphorrhea of more than 3-days and post-operative paresthesia that required drugs. The general complications included death from any cause, MACE. Local complications included MALE, hematoma, active bleeding, local infection, thrombosis, delayed wound healing and false aneurysm
Time Frame
2 years
Title
Primary sustained clinical improvement
Description
defined as a wound healing and rest pain resolution for patients in CLI, without the need for repeated graft it self or anastomoses in surviving patients.
Time Frame
1, 12 and 24 months post procedure
Title
Secondary sustained clinical improvement
Description
defined as primary sustained clinical improvement including the need for repeated graft it self or anastomoses.
Time Frame
1, 12 and 24 months post procedure
Title
Primary patency
Description
defined as a patent graft without any intervention to open up or prevent a graft occlusion. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Time Frame
1 and 24 months post procedure
Title
Major adverse cardiovascular events
Description
defined as MACEs including all cardiac deaths, Q wave infarction, stroke
Time Frame
1, 12 and 24 months post procedure
Title
MALE (Major Adverse Limb Event)-free survival rates in subjects with CLI randomized to Propaten vs. crude ePTFE.
Description
MALE is defined as above-ankle amputation of the index limb or major reintervention (new bypass graft, jump/interposition graft revision, or thrombectomy/ thrombolysis).
Time Frame
1, 6, 12 and 24 months
Title
Limb salvage defined as freedom from above-ankle amputation of the index limb
Time Frame
1, 12 and 24 months post procedure
Title
Secondary patency
Description
secondary patency in which graft patency is lost (occlusion) and restored by thrombectomy, thrombolysis, or transluminal angioplasty, and/or any problems with the graft itself or one of its anastomoses require revision or reconstruction. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Time Frame
1, 12 and 24 months post procedure
Title
Assisted patency
Description
: Assisted patency at 1, 12 and 24 months post procedure, in which patency was never lost but maintained by prophylactic intervention. Demonstrably patent graft should be by a duplex ultrasound color-flow scan.
Time Frame
1, 12 and 24 months post procedure
Title
Death
Description
Death (all cause)
Time Frame
1, 12 and 24 months post procedure
Title
Ankle brachial index
Description
Post-operative assessment (clinical, morphological, hemodynamic criteria)
Time Frame
1, 6, 12 and 24 months post procedure
Title
Quality of life at inclusion, .
Description
assessed according the EQ-5D-3L questionnaire
Time Frame
1, 3, 6, 9, 12, 15, 18 and 24 months
Title
Cost utility analysis (CUA)
Description
In CUA, the outcomes of an intervention are evaluated in terms of Quality-Adjusted Life-Years (QALYs). QALYs are a numerical index that encompasses both the length of life and the health-related quality-of-life.
Time Frame
2 years
Title
cost-effectiveness analysis (CEA)
Description
The Measure of outcome for CEA will be the number of Life Years Gained (LYG) at 2 years
Time Frame
2 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patient ≥18 years
Patient presented critical limb ischemia (Rutherford classification: 4-6)
Indication of below the knee bypass with an artificial graft
Absence of an suitable autologous vein
Patient is affiliated to the Social Security or equivalent system
Patient has been informed of the nature of the study, agrees to its provisions and has signed the informed consent form prior to any study related procedure
Patient agrees to undergo all protocol required follow-up examinations and requirements at the investigational site
Exclusion Criteria:
No atheromatous disease
Female of child bearing potential
Patient has a history of coagulopathy or will refuse blood transfusions
Patient is receiving or scheduled to receive anticancer therapy for malignancy within 1 year prior to or after the procedure
Severe concomitant disease with life expectation < one year
Known allergy to heparin
Indication for ipsilateral major amputation
Patient is not able to give informed consent
Patient is currently participating in an investigational drug or device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints Note: Trials requiring extended follow-up for products that were investigational, but have become commercially suitable since then, are not considered investigational trials
In the Investigator's opinion patient has (a) co-morbid condition(s) that could limit the patient's ability to participate in the study, compliance with follow-up requirements or impact the scientific integrity of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yann Gouëffic, Pr
Organizational Affiliation
Saint Joseph Hospital Paris
Official's Role
Principal Investigator
Facility Information:
Facility Name
Angers University Hospital
City
Angers
ZIP/Postal Code
49 933
Country
France
Facility Name
Besançon University Hospital
City
Besançon
ZIP/Postal Code
25 000
Country
France
Facility Name
Bordeaux University Hospital - Hôpital Pellegrin
City
Bordeaux
ZIP/Postal Code
33000
Country
France
Facility Name
Ambroise Paré university Hospital
City
Boulogne-Billancourt
ZIP/Postal Code
92100
Country
France
Facility Name
Brest University Hospital
City
Brest
ZIP/Postal Code
29200
Country
France
Facility Name
Clermont-Ferrand University Hospital
City
Clermont-Ferrand
ZIP/Postal Code
63 003
Country
France
Facility Name
Dijon University Hospital
City
Dijon
ZIP/Postal Code
21079
Country
France
Facility Name
Lille University Hospital
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Lyon University Hospital - Hopital Edouard Herriot
City
Lyon
ZIP/Postal Code
69003
Country
France
Facility Name
Timone hospital
City
Marseille
ZIP/Postal Code
13005
Country
France
Facility Name
Nancy University Hospital
City
Nancy
ZIP/Postal Code
54500
Country
France
Facility Name
Nantes University Hospital
City
Nantes
ZIP/Postal Code
44800
Country
France
Facility Name
Hopital Pasteur
City
Nice
ZIP/Postal Code
06000
Country
France
Facility Name
Saint Joseph Hospital
City
Paris
ZIP/Postal Code
75014
Country
France
Facility Name
Hôpital Européen Georges Pompidou
City
Paris
ZIP/Postal Code
75015
Country
France
Facility Name
Bichat Hospital
City
Paris
ZIP/Postal Code
75018
Country
France
Facility Name
Poitiers University Hospital
City
Poitiers
ZIP/Postal Code
86000
Country
France
Facility Name
Reims university Hospital
City
Reims
ZIP/Postal Code
51092
Country
France
Facility Name
Saint Etienne University Hospital
City
Saint Etienne
ZIP/Postal Code
42270
Country
France
Facility Name
Nouvel Hopital Civil
City
Strasbourg
ZIP/Postal Code
67091
Country
France
Facility Name
Valenciennes University Hospital
City
Valenciennes
ZIP/Postal Code
59322
Country
France
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Polytetrafluoroethylen (PTFE) Vascular Prostheses With Heparin Bonded Luminal Surfaces vs Crude ePTFE
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