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FLEX Vessel Prep Prior to Angioplasty in Native Arteriovenous Fistulae (AVF)

Primary Purpose

Arteriovenous Fistula Stenosis

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
FLEX Vessel Prep System
Angioplasty
Sponsored by
VentureMed Group Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Arteriovenous Fistula Stenosis

Eligibility Criteria

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

Inclusion Criteria:

  1. Patient is ≥21 years of age.
  2. Patient has a life expectancy of ≥12 months.
  3. Patient has a native AV fistula created ≥ 60 days prior to the index procedure.
  4. The target AV fistula has undergone successful dialysis for at least 8 of 12 sessions during a four-week period.
  5. Patient has a de novo and/or non-stented restenotic lesion located between approximately 2 cm proximal to the arteriovenous anastomosis and axillosubclavian junction with ≥50% stenosis.
  6. Patient has a target lesion (which may include a tandem lesion) that is ≤ 100 mm in length (by visual estimate).

    Note: Tandem lesions may be enrolled provided they meet all of the following criteria:

    • Separated by a gap of ≤ 30mm (3 cm).
    • Total combined lesion length, including 30 mm gap, ≤ 100 mm.
    • Able to be treated as a single lesion.
  7. Patient has a target vessel diameter of 4.0 - 12.0 mm (by visual estimate)
  8. Patient underwent successful crossing of the target lesion with the guidewire.
  9. Patient provides written informed consent prior to enrollment in the study.
  10. Patient is willing to comply with all follow-up evaluations at specified times.

Exclusion Criteria:

  1. Patient is pregnant or breastfeeding.
  2. Patient is receiving immunosuppressive therapy.
  3. Patient has undergone prior intervention of access site within 30 days of index procedure.
  4. Patient with anticipated conversion to peritoneal dialysis.
  5. Patient has an infected AV access or systemic infection.
  6. Patient has planned surgical revision of access site.
  7. Patient with secondary non-target lesion requiring treatment within 30 days post index procedure.
  8. Patient with hemodynamically significant central venous stenoses that cannot be successfully treated prior to treatment of the target lesion.
  9. Patient with target AVF or access circuit which previously had thrombectomy within last 30 days.
  10. Patients judged to have a lesion that prevents complete inflation of an angioplasty balloon or proper placement of the delivery system.
  11. Patient with target lesion located central to the axillosubclavian junction.
  12. Patient has significant arterial inflow lesion requiring treatment more than 2 cm upstream from the anastomosis in the AV access.
  13. Patient has presence of pseudoaneurysm or aneurysm requiring surgical revision at the target lesion site.
  14. Patient with known contraindication, including allergic reaction, or sensitivity to contrast material that cannot be adequately pre-treated.
  15. Patient who cannot receive recommended antiplatelet and/or anticoagulant therapy.
  16. Patient with clinically significant Steal Syndrome requiring treatment.
  17. Patient is enrolled in another investigational drug, device, or biologic study and has not completed the primary endpoint or was previously enrolled in this study.
  18. Patient has a co-morbid condition that, in the judgment of the Investigator, may cause him/her to be non-compliant with the protocol or confound the data interpretation.
  19. Patient has AV fistula created via endovascular technique.

Sites / Locations

  • AKDHC Medical Research Services
  • Open Access Vascular Access
  • Minneapolis Vascular Surgery Center
  • Metrolina Nephrology Associates
  • North Carolina Nephrology
  • Dialysis Access Institute
  • Dallas Nephrology Associates

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

FLEX Vessel Prep System followed with PTA (TEST arm)

PTA only (CONTROL arm)

Arm Description

FLEX Vessel Prep System is used to create circumferential, continuous micro-incisions along the length of the stenosis by performing a retrograde pullback through the lesion. Following FLEX, standard balloon angioplasty is performed with an uncoated PTA balloon sized to meet the reference vessel diameter, according to its corresponding instructions for use. Once advanced to the lesion, the balloon should be inflated according to the site's standard of care.

Standard Balloon angioplasty is performed with an uncoated PTA balloon sized to meet the reference vessel diameter, according to its corresponding instructions for use. Once advanced to the lesion, the balloon should be inflated according to the site's standard of care.

Outcomes

Primary Outcome Measures

Primary Safety Endpoint: Serious Adverse Event Rate
Defined as the Serious Adverse Event (SAE) rate involving the AV access circuit through 30 days post- procedure.
Primary Efficacy Endpoint: Target Lesion Primary Patency Rate
Defined as freedom from clinically driven target lesion re-intervention (CD-TLR) or access circuit thrombosis measured through 6 months post-procedure.

Secondary Outcome Measures

Secondary Safety Endpoint: Serious Adverse Event Rate within 3 and 6 Months
Defined as the Serious Adverse Event (SAE) rate involving the AV access circuit through 3 months and 6 months post-procedure.
Access Circuit Primary Patency through 3 Months and 6 Months Post-Procedure
Defined as freedom from re-intervention in the access circuit or access circuit thrombosis through 3 months and 6 months post-procedure.
Target Lesion Primary Patency through 3 Months and 6 Months Post- Procedure
Defined as freedom from CD-TLR or access thrombosis occurring in the target lesion through 3 months and 6 months post-procedure.
Cumulative Target Lesion Reinterventions Measured through 3 Months and 6 Months Post-Procedure
Defined as proportion of subjects with TLR through 3 months and 6 months post-procedure.
Number of Interventions Required to Maintain Target Lesion Patency through 3 Months and 6 Months Post-Procedure
Defined as number of TLR through 3 months and 6 months post-procedure.
Number of Interventions Required to Maintain Access Circuit Patency through 3 Months and 6 Months Post-Procedure
Defined as number of reinterventions in the target lesion and/or access circuit through 3 months and 6 months post-procedure.
Cumulative Access Circuit Thromboses Measured through 3 Months and 6 months Post-Procedure.
Defined as proportion of subjects with access circuit thrombosis through 3 months and 6 months post-procedure.
Device Success
Defined as successful delivery, treatment, and retrieval of the FLEX Vessel Prep device at index procedure.
Procedural Success
Defined as maintenance of patency (≤30% residual stenosis) in the absence of peri-procedural Serious Adverse Event (SAE).
Clinical Success
Defined as resumption of successful dialysis for at least one session after index procedure.
Balloon opening pressure
Defined as minimum inflation pressure required to efface target lesion noting parallel balloon walls.
Maximum balloon pressure
Maximum pressure of angioplasty balloon(s) required during the interventional procedure to treat target lesion.
Patient Reported Pain
Patient Reported Pain during the interventional procedure reported via Numerical Rating Scale (NRS).

Full Information

First Posted
August 27, 2021
Last Updated
March 3, 2023
Sponsor
VentureMed Group Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05034939
Brief Title
FLEX Vessel Prep Prior to Angioplasty in Native Arteriovenous Fistulae (AVF)
Official Title
FLEX Vessel Prep Prior to the Treatment of Obstructive Lesions in the Native Arteriovenous Dialysis Fistulae
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
September 2, 2021 (Actual)
Primary Completion Date
December 1, 2022 (Actual)
Study Completion Date
December 1, 2022 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
A prospective, multi-center, randomized (1:1) clinical study evaluating the FLEX Vessel Prep device plus percutaneous angioplasty (PTA) (study arm) vs PTA alone (control arm) for the treatment of obstructive lesions in the native arteriovenous dialysis fistulae.
Detailed Description
This is a prospective, multi- center, randomized (1:1) clinical study evaluating the FLEX Vessel Prep System followed with PTA (TEST arm) vs PTA alone (CONTROL arm) for the treatment of de novo or non-stented restenotic obstructive lesions up to 100 mm in length located in the arteriovenous dialysis fistulae in an upper extremity. The objective is to evaluate and compare the serious adverse event rate at 30 days and primary patency at 6 months when using FLEX Vessel Prep System prior to PTA vs. PTA alone for treatment of obstructive lesion of native arteriovenous fistulae in the upper extremity. Enrollment will continue until complete data sets are collected for up to 75 subjects from up to 7 sites in the US.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Arteriovenous Fistula Stenosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
75 (Actual)

8. Arms, Groups, and Interventions

Arm Title
FLEX Vessel Prep System followed with PTA (TEST arm)
Arm Type
Active Comparator
Arm Description
FLEX Vessel Prep System is used to create circumferential, continuous micro-incisions along the length of the stenosis by performing a retrograde pullback through the lesion. Following FLEX, standard balloon angioplasty is performed with an uncoated PTA balloon sized to meet the reference vessel diameter, according to its corresponding instructions for use. Once advanced to the lesion, the balloon should be inflated according to the site's standard of care.
Arm Title
PTA only (CONTROL arm)
Arm Type
Active Comparator
Arm Description
Standard Balloon angioplasty is performed with an uncoated PTA balloon sized to meet the reference vessel diameter, according to its corresponding instructions for use. Once advanced to the lesion, the balloon should be inflated according to the site's standard of care.
Intervention Type
Device
Intervention Name(s)
FLEX Vessel Prep System
Intervention Description
The FLEX Vessel Prep System™ is an over-the-wire sheathed catheter with a three-strut treatment element near the distal tip. As the device is pulled back in a retrograde fashion through the target lesion, the Treatment Element "flexes" providing continuous engagement along the lesion to create controlled depth micro-incisions.
Intervention Type
Device
Intervention Name(s)
Angioplasty
Intervention Description
The brand and type of PTA balloon(s) used will be at the discretion of the treating physician and used according to its Instructions for Use (IFU). PTA balloons consist of an over-the-wire catheter with a balloon fixed at the distal tip. Within the lesion the balloon is inflated to a pressure that allows full effacement.
Primary Outcome Measure Information:
Title
Primary Safety Endpoint: Serious Adverse Event Rate
Description
Defined as the Serious Adverse Event (SAE) rate involving the AV access circuit through 30 days post- procedure.
Time Frame
30 Days
Title
Primary Efficacy Endpoint: Target Lesion Primary Patency Rate
Description
Defined as freedom from clinically driven target lesion re-intervention (CD-TLR) or access circuit thrombosis measured through 6 months post-procedure.
Time Frame
6 Months
Secondary Outcome Measure Information:
Title
Secondary Safety Endpoint: Serious Adverse Event Rate within 3 and 6 Months
Description
Defined as the Serious Adverse Event (SAE) rate involving the AV access circuit through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Access Circuit Primary Patency through 3 Months and 6 Months Post-Procedure
Description
Defined as freedom from re-intervention in the access circuit or access circuit thrombosis through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Target Lesion Primary Patency through 3 Months and 6 Months Post- Procedure
Description
Defined as freedom from CD-TLR or access thrombosis occurring in the target lesion through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Cumulative Target Lesion Reinterventions Measured through 3 Months and 6 Months Post-Procedure
Description
Defined as proportion of subjects with TLR through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Number of Interventions Required to Maintain Target Lesion Patency through 3 Months and 6 Months Post-Procedure
Description
Defined as number of TLR through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Number of Interventions Required to Maintain Access Circuit Patency through 3 Months and 6 Months Post-Procedure
Description
Defined as number of reinterventions in the target lesion and/or access circuit through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Cumulative Access Circuit Thromboses Measured through 3 Months and 6 months Post-Procedure.
Description
Defined as proportion of subjects with access circuit thrombosis through 3 months and 6 months post-procedure.
Time Frame
3 and 6 Months
Title
Device Success
Description
Defined as successful delivery, treatment, and retrieval of the FLEX Vessel Prep device at index procedure.
Time Frame
Procedure
Title
Procedural Success
Description
Defined as maintenance of patency (≤30% residual stenosis) in the absence of peri-procedural Serious Adverse Event (SAE).
Time Frame
Procedure
Title
Clinical Success
Description
Defined as resumption of successful dialysis for at least one session after index procedure.
Time Frame
30 Days
Title
Balloon opening pressure
Description
Defined as minimum inflation pressure required to efface target lesion noting parallel balloon walls.
Time Frame
Procedure
Title
Maximum balloon pressure
Description
Maximum pressure of angioplasty balloon(s) required during the interventional procedure to treat target lesion.
Time Frame
Procedure
Title
Patient Reported Pain
Description
Patient Reported Pain during the interventional procedure reported via Numerical Rating Scale (NRS).
Time Frame
Procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient is ≥21 years of age. Patient has a life expectancy of ≥12 months. Patient has a native AV fistula created ≥ 60 days prior to the index procedure. The target AV fistula has undergone successful dialysis for at least 8 of 12 sessions during a four-week period. Patient has a de novo and/or non-stented restenotic lesion located between approximately 2 cm proximal to the arteriovenous anastomosis and axillosubclavian junction with ≥50% stenosis. Patient has a target lesion (which may include a tandem lesion) that is ≤ 100 mm in length (by visual estimate). Note: Tandem lesions may be enrolled provided they meet all of the following criteria: Separated by a gap of ≤ 30mm (3 cm). Total combined lesion length, including 30 mm gap, ≤ 100 mm. Able to be treated as a single lesion. Patient has a target vessel diameter of 4.0 - 12.0 mm (by visual estimate) Patient underwent successful crossing of the target lesion with the guidewire. Patient provides written informed consent prior to enrollment in the study. Patient is willing to comply with all follow-up evaluations at specified times. Exclusion Criteria: Patient is pregnant or breastfeeding. Patient is receiving immunosuppressive therapy. Patient has undergone prior intervention of access site within 30 days of index procedure. Patient with anticipated conversion to peritoneal dialysis. Patient has an infected AV access or systemic infection. Patient has planned surgical revision of access site. Patient with secondary non-target lesion requiring treatment within 30 days post index procedure. Patient with hemodynamically significant central venous stenoses that cannot be successfully treated prior to treatment of the target lesion. Patient with target AVF or access circuit which previously had thrombectomy within last 30 days. Patients judged to have a lesion that prevents complete inflation of an angioplasty balloon or proper placement of the delivery system. Patient with target lesion located central to the axillosubclavian junction. Patient has significant arterial inflow lesion requiring treatment more than 2 cm upstream from the anastomosis in the AV access. Patient has presence of pseudoaneurysm or aneurysm requiring surgical revision at the target lesion site. Patient with known contraindication, including allergic reaction, or sensitivity to contrast material that cannot be adequately pre-treated. Patient who cannot receive recommended antiplatelet and/or anticoagulant therapy. Patient with clinically significant Steal Syndrome requiring treatment. Patient is enrolled in another investigational drug, device, or biologic study and has not completed the primary endpoint or was previously enrolled in this study. Patient has a co-morbid condition that, in the judgment of the Investigator, may cause him/her to be non-compliant with the protocol or confound the data interpretation. Patient has AV fistula created via endovascular technique.
Facility Information:
Facility Name
AKDHC Medical Research Services
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85012
Country
United States
Facility Name
Open Access Vascular Access
City
Miami
State/Province
Florida
ZIP/Postal Code
33169
Country
United States
Facility Name
Minneapolis Vascular Surgery Center
City
New Brighton
State/Province
Minnesota
ZIP/Postal Code
55112
Country
United States
Facility Name
Metrolina Nephrology Associates
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28208
Country
United States
Facility Name
North Carolina Nephrology
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27610
Country
United States
Facility Name
Dialysis Access Institute
City
Orangeburg
State/Province
South Carolina
ZIP/Postal Code
29118
Country
United States
Facility Name
Dallas Nephrology Associates
City
Dallas
State/Province
Texas
ZIP/Postal Code
75235
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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FLEX Vessel Prep Prior to Angioplasty in Native Arteriovenous Fistulae (AVF)

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