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Clinical Evaluation of a Vascular Venous Anastomotic Connector [InterGraft VIG-only Study]

Primary Purpose

End Stage Renal Disease

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Venous InterGraft Connector
Sponsored by
Phraxis, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for End Stage Renal Disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject is ≥ 18 years of age.
  2. Subject requires the creation of a vascular access graft for hemodialysis, secondary to a diagnosis of End Stage Renal Disease.
  3. Subject is able to have the vascular access graft placed in an upper extremity.
  4. Baseline imaging shows suitable vascular anatomy/ vessel size for the InterGraft™ Venous Connector and an artery at least 3.5 mm in diameter that is suitable for creating the arterial anastomosis.
  5. Subject has a reasonable expectation of remaining on hemodialysis for at least 6 months.
  6. Subject or his/her legal guardian understands the study and is willing and able to comply with the dialysis schedule and follow-up requirements.
  7. Subject or his/her legal guardian provides written informed consent. NOTE: In accordance with the requirements of some Institutional Review Boards, where applicable, only those subjects with capacity to consent for themselves will be included. Thus, where required by the Institutional Review Board, adult individuals who lack capacity to consent for themselves will be excluded from the study.
  8. Physician's examination at time of surgery shows no significant vessel lesions, calcification(s), anatomic structures or abnormalities that may limit ability to safely deploy the InterGraft Connectors or create a sutured arterial anastomosis.

Exclusion Criteria:

  1. Subject has a documented and unsuccessfully treated ipsilateral central venous stenosis as determined by imaging.
  2. Subject currently has a known or suspected bacterial, fungal, or HIV infection. NOTE: Patients with hepatitis B or C may be included in the study.
  3. Subject has a known hypercoagulable or bleeding disorder or requires treatment with warfarin or heparin.

    NOTE: The intent of this criterion is to exclude patients with high risk for bleeding or clotting complications. As such, patients who are taking oral anticoagulants (blood thinners) including, but not limited to, Xarelto® (rivaroxaban) or Eliquis® (apixaban) should also be excluded from the study. Patients may receive anticoagulation therapy any time after the study AV graft implant procedure, at their physician's discretion. This should be driven by an indication unrelated to the vascular access.

  4. Subject has had a previous instance of Heparin Induced Thrombocytopenia type 2 (HIT-2) or has known sensitivity to heparin.
  5. Subject has co-morbid conditions that may limit their ability to comply with study and follow-up requirements.
  6. The patient has had >2 previous arteriovenous accesses in treatment arm.
  7. Subject is currently taking Aggrenox®.
  8. Subject is in need of, or is scheduled for any major surgery within 30 days of the study procedure.
  9. Subject is currently taking maintenance immunosuppressant medication such as rapamycin, mycophenolate or mycophenolic acid, prednisone (>10 mg), cyclosporine, tacrolimus or cyclophosphamide.
  10. Life expectancy is less than 12 months.
  11. Subject is pregnant. NOTE: A negative urine pregnancy test within 24 hours of the study procedure is required in all female subjects with reproductive capacity.
  12. Subject is a poor compliance risk (i.e. history of IV or oral drug abuse).
  13. The subject is enrolled in another dialysis or vascular investigational study.

Sites / Locations

  • Triad of Alabama/Flowers Hospital
  • Cartersville Medical Center, LLC
  • Medical Center of Central Georgia - Navicent Health
  • Henry Ford Health System- Dept of Surgery
  • Saint Louis University
  • Surgical Specialists of Charlotte
  • Medical University of South Carolina
  • McLeod Physician Associates II
  • Regional Medical Center of Orangeburg and Calhoun Counties
  • Spartanburg Regional Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Venous InterGraft Connector (VIG)

Arm Description

All enrolled patients are assigned to the same treatment: AVG implantation using a VIG to create the venous anastomosis, with standard suturing of the arterial anastomosis. In standard use, both the arterial and venous graft anastomoses are sutured. The VIG is intended to replace suturing of the venous anastomosis.

Outcomes

Primary Outcome Measures

Cumulative Patency
Percentage of subjects free from loss of access of the study graft for hemodialysis

Secondary Outcome Measures

Acute device success
AV graft flow at end of implant procedure
Primary unassisted patency
Percentage of subjects free from the occurrence of either access thrombosis or an access procedure performed to maintain access patency
Time to first cannulation
Time from initial access placement to first graft cannulation for hemodialysis
Interventions required to maintain patency
Number and type of interventions required to maintain secondary patency
Serious Adverse Events
Number and type of serious adverse events- death, emergent surgery, significant bleeding,graft infection, pseudoaneurysm

Full Information

First Posted
August 19, 2015
Last Updated
July 5, 2023
Sponsor
Phraxis, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02532621
Brief Title
Clinical Evaluation of a Vascular Venous Anastomotic Connector [InterGraft VIG-only Study]
Official Title
Clinical Evaluation of a Vascular Venous Anastomotic Connector for Minimally Invasive Connection of an Arteriovenous Graft for Hemodialysis [InterGraft VIG-only Study]
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Completed
Study Start Date
February 21, 2018 (Actual)
Primary Completion Date
January 19, 2022 (Actual)
Study Completion Date
January 19, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Phraxis, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The InterGraft™ Venous Anastomotic Connector provides an endovascular, minimally invasive means for attachment of an arteriovenous graft to a vein in the upper extremity. The InterGraft™ Venous Anastomotic Connector facilitates creation of the arteriovenous graft connection to a vein in support of hemodialysis in subjects with End Stage Renal Disease. The InterGraft™ Venous Anastomotic Connector is used together with conventional suturing of the arterial anastomosis to facilitate creation of an arteriovenous graft in support of hemodialysis in subjects with End Stage Renal Disease.
Detailed Description
The InterGraft™ Venous Anastomotic Connector (VIG) was developed for endovascular, minimally invasive venous anastomosis of a standard arteriovenous graft (AVG) for hemodialysis. This study will evaluate the safety and performance of the VIG for anastomosis of a commercially available, 6 mm diameter, synthetic AVG. Anastomoses with the VIG may potentially reduce venous vessel trauma, improve the local vessel wall shear stresses and promote laminar flow, thereby improving patency. While recognizing that a native fistula is the recommended access for hemodialysis, AVGs remain a frequently used access type. This study focuses on subjects who have a failed fistula, cannot have a fistula or are better suited for an AVG, as determined by the physician. The implant procedural outcomes, the number and type of major adverse events, and patency throughout a six-month follow-up period will be evaluated. The six-month patency rate will be compared with a pre-specified patency performance goal drawn from surgical AVG literature and published performance standards. This is a pivotal, multicenter, prospective, non-randomized design study. All enrolled subjects will receive the VIG device and will have a standard sutured arterial anastomosis. A total of 158 evaluable subjects will be enrolled, defined as primary analysis population of 146 subjects plus allowance for 12 subjects lost-to-follow up. The study includes10 participating clinical centers. Study site investigators are physicians skilled in AVG placement and interventional techniques. Study data will be collected up to the point at which each subject has completed the six-month endpoint or experienced a terminal study endpoint. The study will be conducted in compliance with the Investigational Plan, Investigational Device Exemption regulations, Good Clinical Practice guidelines, and other applicable regulatory requirements.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
End Stage Renal Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
158 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Venous InterGraft Connector (VIG)
Arm Type
Experimental
Arm Description
All enrolled patients are assigned to the same treatment: AVG implantation using a VIG to create the venous anastomosis, with standard suturing of the arterial anastomosis. In standard use, both the arterial and venous graft anastomoses are sutured. The VIG is intended to replace suturing of the venous anastomosis.
Intervention Type
Device
Intervention Name(s)
Venous InterGraft Connector
Other Intervention Name(s)
VIG
Intervention Description
The device is designed for transcatheter delivery within a vein and connection to an AVG that has been tunneled under the skin in a standard manner. The connection is made via a small skin incision.
Primary Outcome Measure Information:
Title
Cumulative Patency
Description
Percentage of subjects free from loss of access of the study graft for hemodialysis
Time Frame
Six Months
Secondary Outcome Measure Information:
Title
Acute device success
Description
AV graft flow at end of implant procedure
Time Frame
24 hours
Title
Primary unassisted patency
Description
Percentage of subjects free from the occurrence of either access thrombosis or an access procedure performed to maintain access patency
Time Frame
Six months
Title
Time to first cannulation
Description
Time from initial access placement to first graft cannulation for hemodialysis
Time Frame
Six months
Title
Interventions required to maintain patency
Description
Number and type of interventions required to maintain secondary patency
Time Frame
Six months
Title
Serious Adverse Events
Description
Number and type of serious adverse events- death, emergent surgery, significant bleeding,graft infection, pseudoaneurysm
Time Frame
Six months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is ≥ 18 years of age. Subject requires the creation of a vascular access graft for hemodialysis, secondary to a diagnosis of End Stage Renal Disease. Subject is able to have the vascular access graft placed in an upper extremity. Baseline imaging shows suitable vascular anatomy/ vessel size for the InterGraft™ Venous Connector and an artery at least 3.5 mm in diameter that is suitable for creating the arterial anastomosis. Subject has a reasonable expectation of remaining on hemodialysis for at least 6 months. Subject or his/her legal guardian understands the study and is willing and able to comply with the dialysis schedule and follow-up requirements. Subject or his/her legal guardian provides written informed consent. NOTE: In accordance with the requirements of some Institutional Review Boards, where applicable, only those subjects with capacity to consent for themselves will be included. Thus, where required by the Institutional Review Board, adult individuals who lack capacity to consent for themselves will be excluded from the study. Physician's examination at time of surgery shows no significant vessel lesions, calcification(s), anatomic structures or abnormalities that may limit ability to safely deploy the InterGraft Connectors or create a sutured arterial anastomosis. Exclusion Criteria: Subject has a documented and unsuccessfully treated ipsilateral central venous stenosis as determined by imaging. Subject currently has a known or suspected bacterial, fungal, or HIV infection. NOTE: Patients with hepatitis B or C may be included in the study. Subject has a known hypercoagulable or bleeding disorder or requires treatment with warfarin or heparin. NOTE: The intent of this criterion is to exclude patients with high risk for bleeding or clotting complications. As such, patients who are taking oral anticoagulants (blood thinners) including, but not limited to, Xarelto® (rivaroxaban) or Eliquis® (apixaban) should also be excluded from the study. Patients may receive anticoagulation therapy any time after the study AV graft implant procedure, at their physician's discretion. This should be driven by an indication unrelated to the vascular access. Subject has had a previous instance of Heparin Induced Thrombocytopenia type 2 (HIT-2) or has known sensitivity to heparin. Subject has co-morbid conditions that may limit their ability to comply with study and follow-up requirements. The patient has had >2 previous arteriovenous accesses in treatment arm. Subject is currently taking Aggrenox®. Subject is in need of, or is scheduled for any major surgery within 30 days of the study procedure. Subject is currently taking maintenance immunosuppressant medication such as rapamycin, mycophenolate or mycophenolic acid, prednisone (>10 mg), cyclosporine, tacrolimus or cyclophosphamide. Life expectancy is less than 12 months. Subject is pregnant. NOTE: A negative urine pregnancy test within 24 hours of the study procedure is required in all female subjects with reproductive capacity. Subject is a poor compliance risk (i.e. history of IV or oral drug abuse). The subject is enrolled in another dialysis or vascular investigational study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cindy M Setum, Ph.D
Organizational Affiliation
Phraxis, Inc.
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
John R Ross, M.D.
Organizational Affiliation
Regional Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Triad of Alabama/Flowers Hospital
City
Dothan
State/Province
Alabama
ZIP/Postal Code
36305
Country
United States
Facility Name
Cartersville Medical Center, LLC
City
Cartersville
State/Province
Georgia
ZIP/Postal Code
30120
Country
United States
Facility Name
Medical Center of Central Georgia - Navicent Health
City
Macon
State/Province
Georgia
ZIP/Postal Code
31201
Country
United States
Facility Name
Henry Ford Health System- Dept of Surgery
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Facility Name
Saint Louis University
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63103
Country
United States
Facility Name
Surgical Specialists of Charlotte
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28207
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States
Facility Name
McLeod Physician Associates II
City
Florence
State/Province
South Carolina
ZIP/Postal Code
29506
Country
United States
Facility Name
Regional Medical Center of Orangeburg and Calhoun Counties
City
Orangeburg
State/Province
South Carolina
ZIP/Postal Code
29118-1498
Country
United States
Facility Name
Spartanburg Regional Medical Center
City
Spartanburg
State/Province
South Carolina
ZIP/Postal Code
29303
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
Citation
U.S. Renal Data System. USRDS 2011 Annual Data Report: Volume 2. Atlas of End Stage Renal Disease in the United States. Bethesda, MD, National Institutes of Health, National Institutes of Diabetes, and Digestive and Kidney Diseases; 2011
Results Reference
background
PubMed Identifier
18477783
Citation
Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, Himmelfarb J, Vazquez MA, Gassman JJ, Greene T, Radeva MK, Braden GL, Ikizler TA, Rocco MV, Davidson IJ, Kaufman JS, Meyers CM, Kusek JW, Feldman HI; Dialysis Access Consortium Study Group. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA. 2008 May 14;299(18):2164-71. doi: 10.1001/jama.299.18.2164.
Results Reference
background
PubMed Identifier
19670164
Citation
Akoh JA. Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access. 2009 Jul-Sep;10(3):137-47. doi: 10.1177/112972980901000301.
Results Reference
background
PubMed Identifier
12596755
Citation
Roy-Chaudhury P, Kelly BS, Zhang J, Narayana A, Desai P, Melham M, Duncan H, Heffelfinger SC. Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies. Blood Purif. 2003;21(1):99-110. doi: 10.1159/000067863.
Results Reference
background
PubMed Identifier
19695501
Citation
Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis. 2009 Sep;16(5):329-38. doi: 10.1053/j.ackd.2009.06.009.
Results Reference
background
PubMed Identifier
16988062
Citation
Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol. 2006 Nov;17(11):3204-12. doi: 10.1681/ASN.2006030190. Epub 2006 Sep 20.
Results Reference
background
PubMed Identifier
23173947
Citation
Lee HW, Allon M. When should a patient receive an arteriovenous graft rather than a fistula? Semin Dial. 2013 Jan-Feb;26(1):6-10. doi: 10.1111/sdi.12040. Epub 2012 Nov 22.
Results Reference
background
PubMed Identifier
36895157
Citation
Burgess JS, Beaver JD, London M, Rohan V, Orland P, Yevzlin A, Setum C, Ross J; InterGraft Study Investigators. Prospective multicenter study of a novel endovascular venous anastomotic procedure and device for implantation of an arteriovenous graft for hemodialysis. J Vasc Access. 2023 Mar 9:11297298231159691. doi: 10.1177/11297298231159691. Online ahead of print.
Results Reference
result

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Clinical Evaluation of a Vascular Venous Anastomotic Connector [InterGraft VIG-only Study]

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