Pivotal Study for the FLAIR Endovascular Stent Graft
Primary Purpose
Stenoses
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
FLAIR Endovascular Stent Graft
PTA
FLAIR Endovascular Stent Graft
Sponsored by
About this trial
This is an interventional treatment trial for Stenoses focused on measuring Hemodialysis, Vascular Prosthesis, stenoses, grafts
Eligibility Criteria
Inclusion Criteria:
- Male or female patients between 18 to 90 years of age whose hemodialysis access was a synthetic AV access graft located in an arm.
- Angiographic evidence of one or more stenoses, 7 cm or less in length and greater than or equal to 50%, at the graft-vein anastomosis of a synthetic AV access graft. The entire lesion must have been located within 7 cm of the anastomosis such that approximately 1 cm of the IMPRA/Bard Device must have extended into non-diseased vein and approximately 1 cm, but no more than 2 cm, of the IMPRA/Bard Device will be extended into non-diseased AV graft.
- Clinical evidence of a hemodynamically significant stenosis.
- Percutaneous endovascular therapy for the identified lesion was the best treatment choice in the opinion of the investigator.
- Patients must have been able to understand and provide informed consent.
- Patients whose synthetic AV access grafts had been implanted greater than 30 days and had undergone 1 or more successful hemodialysis sessions.
- During primary balloon angioplasty, full expansion of an appropriately sized angioplasty balloon, in the operator's judgment, must have been achieved.
Exclusion Criteria:
- Concomitant disease (e.g., terminal cancer) or other medical condition that was likely to result in death of the patient within 6 months of the time of implantation.
- Stenoses that had a corresponding thrombosis treated within 7 days.
- The presence of a second lesion in the access circuit less than or equal to 3 cm from the edges of the primary lesion that was treated within 30 days or that was greater than or equal to 30%. Access circuit was defined as the area from the AV access graft arterial anastomosis to the superior vena cava-right atrial junction.
- The presence of a second lesion in the access circuit greater than 3 cm from the edges of the primary lesion that was greater than or equal to 30%. Second lesions that were greater than or equal to 30% must have been treated prior to patient inclusion to reduce the percent stenosis to less than 30%.
- Patients who were unwilling or unable to return for follow-up visits or patients with whom follow-up visits may have been unreliable.
- Patients who had a stent placed at the target lesion site.
- Patients with a blood coagulative disorder or sepsis.
- Patients in which the IMPRA/Bard Device would have been required to cross an angle (between the inflow vein and synthetic AV access graft) that was greater than 90 degrees.
- Patients in which the IMPRA/Bard Device would have been required to be deployed fully across the elbow joint, which is identified radiographically by a combination of the humeroulnar joint and the humeroradial joint.
- Patients with a contraindication to the use of contrast media.
- Patients whose AV access graft was infected.
- Patients who were currently or were scheduled to enroll in other investigations that conflicted with follow-up testing or confounds data in this trial.
- Procedural use of another investigational device.
- Patients who were pregnant.
Sites / Locations
- New York Presbyterian Hospital/Columbia
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Active Comparator
Experimental
Arm Label
FLAIR
PTA Only
FLAIR Roll-in Participants
Arm Description
Primary PTA followed by placement of the FLAIR Endovascular Stent Graft
Percutaneous Transluminal Angioplasty
Primary Patency followed by placement of the FLAIR Endovascular Stent Graft. Roll-in participants were enrolled in the study for training purposes and were not randomized.
Outcomes
Primary Outcome Measures
Percent of Participants With Treatment Area Primary Patency (TAPP)
TAPP was defined as patency (open to blood flow) after the study index procedure until reintervention in the treatment area (within 5 mm proximal or 5 mm distal to the study device or index balloon angioplasty treatment area), or thrombotic occlusion that involved the treatment area.
Secondary Outcome Measures
Total Number of Adverse Events
The safety endpoint was evaluated based on the incidence of adverse events observed within the same time interval. An adverse event was defined as any undesirable clinical occurrence in a patient that (a) is considered possibly or definietly device related by the investigator, (b) involves the access circuit (AV graft arterial anastomosis to the superior vena cava-right atrial junction) or the arm where the access circuit is located or (c) the investigator considers relevant to the objectives of this study. An adverse event could be mild, moderate or severe.
Percent of Participants With Successful Delivery of the Device
The ability to successfully deliver the FLAIR™ Endovascular Stent Graft. Successful delivery is the ability to deliver and seat the implant in the intended location of a stenosed segment of the venous anastomosis region of a synthetic access graft. This attribute is only applicable to the FLAIR and FLAIR Roll-in arms.
Percent of Participants With Procedural Success
Procedural Success was defined as anatomic success (<30% residual stenosis) and at least one indicator of hemodynamic or clinical success
Percent of Participants With TAPP
TAPP was defined as patency (open to blood flow) after the study index procedure until reintervention in the treatment area (within 5 mm proximal or 5 mm distal to the study device or index balloon angioplasty treatment area), or thrombotic occlusion that involved the treatment area.
Percent of Participants With Access Circuit Primary Patency (ACPP)
ACCP defined as patency (open to blood flow) following the index study procedure until access thrombosis or an intervention of a lesion anywhere within the access circuit.
Percent of Participants With Access Circuit Assisted Primary Patency (ACAPP)
ACAPP defined as patency (open to blood flow)following the index study procedure until access thrombosis or a surgical intervention that excludes the treated lesion from the access circuit.
Percent of Participants With Access Circuit Cumulative Patency (ACCP or Secondary Patency)
ACCP defined as patency (open to blood flow) following the index study procedure until the access is surgically revised or abandoned because of the inability to treat the original lesion. Multiple treatments for occlusions to restore patency are compatible with ACCP.
Percent of Participants With Binary Restenosis
Binary restenosis defined as lesions with greater than or equal to 50% diameter stenosis of the treatment area (calculated by a core lab).
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT00678249
Brief Title
Pivotal Study for the FLAIR Endovascular Stent Graft
Official Title
A Prospective, Multi-Center, Randomized Evaluation of an IMPRA/Bard ePTFE Encapsulated Carbon Lined Nitinol Endoluminal Device for AV Access Graft Stenoses
Study Type
Interventional
2. Study Status
Record Verification Date
May 2011
Overall Recruitment Status
Completed
Study Start Date
January 2001 (undefined)
Primary Completion Date
June 2004 (Actual)
Study Completion Date
June 2004 (Actual)
3. Sponsor/Collaborators
Name of the Sponsor
C. R. Bard
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study compared the FLAIR™ Endovascular Stent Graft to balloon angioplasty in patients with stenoses at the venous anastomosis of a synthetic AV access graft.
Detailed Description
A total of 227 patients were treated at 16 U.S. investigational sites to evaluate the safety and effectiveness of the FLAIR™ Endovascular Stent Graft. This study compared the FLAIR™ Endovascular Stent Graft to balloon angioplasty in patients with stenoses at the venous anastomosis of a synthetic AV access graft.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stenoses
Keywords
Hemodialysis, Vascular Prosthesis, stenoses, grafts
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
227 (Actual)
8. Arms, Groups, and Interventions
Arm Title
FLAIR
Arm Type
Experimental
Arm Description
Primary PTA followed by placement of the FLAIR Endovascular Stent Graft
Arm Title
PTA Only
Arm Type
Active Comparator
Arm Description
Percutaneous Transluminal Angioplasty
Arm Title
FLAIR Roll-in Participants
Arm Type
Experimental
Arm Description
Primary Patency followed by placement of the FLAIR Endovascular Stent Graft. Roll-in participants were enrolled in the study for training purposes and were not randomized.
Intervention Type
Device
Intervention Name(s)
FLAIR Endovascular Stent Graft
Other Intervention Name(s)
Flair, Stent Graft
Intervention Description
Primary balloon angioplasty followed by placement of the FLAIR Endovascular Stent Graft
Intervention Type
Procedure
Intervention Name(s)
PTA
Other Intervention Name(s)
Flair, Stent Graft
Intervention Description
Percutaneous Transluminal Angioplasty
Intervention Type
Device
Intervention Name(s)
FLAIR Endovascular Stent Graft
Other Intervention Name(s)
Flair, Stent Graft
Intervention Description
Primary PTA followed by placement of the FLAIR Endovascular Stent Graft. Roll-in participants were enrolled in the study for training purposes and were not randomized.
Primary Outcome Measure Information:
Title
Percent of Participants With Treatment Area Primary Patency (TAPP)
Description
TAPP was defined as patency (open to blood flow) after the study index procedure until reintervention in the treatment area (within 5 mm proximal or 5 mm distal to the study device or index balloon angioplasty treatment area), or thrombotic occlusion that involved the treatment area.
Time Frame
6 month follow-up
Secondary Outcome Measure Information:
Title
Total Number of Adverse Events
Description
The safety endpoint was evaluated based on the incidence of adverse events observed within the same time interval. An adverse event was defined as any undesirable clinical occurrence in a patient that (a) is considered possibly or definietly device related by the investigator, (b) involves the access circuit (AV graft arterial anastomosis to the superior vena cava-right atrial junction) or the arm where the access circuit is located or (c) the investigator considers relevant to the objectives of this study. An adverse event could be mild, moderate or severe.
Time Frame
6 month Follow-Up
Title
Percent of Participants With Successful Delivery of the Device
Description
The ability to successfully deliver the FLAIR™ Endovascular Stent Graft. Successful delivery is the ability to deliver and seat the implant in the intended location of a stenosed segment of the venous anastomosis region of a synthetic access graft. This attribute is only applicable to the FLAIR and FLAIR Roll-in arms.
Time Frame
Index Procedure
Title
Percent of Participants With Procedural Success
Description
Procedural Success was defined as anatomic success (<30% residual stenosis) and at least one indicator of hemodynamic or clinical success
Time Frame
Index Procedure
Title
Percent of Participants With TAPP
Description
TAPP was defined as patency (open to blood flow) after the study index procedure until reintervention in the treatment area (within 5 mm proximal or 5 mm distal to the study device or index balloon angioplasty treatment area), or thrombotic occlusion that involved the treatment area.
Time Frame
2 month Follow-Up
Title
Percent of Participants With Access Circuit Primary Patency (ACPP)
Description
ACCP defined as patency (open to blood flow) following the index study procedure until access thrombosis or an intervention of a lesion anywhere within the access circuit.
Time Frame
6 month Follow-Up
Title
Percent of Participants With Access Circuit Assisted Primary Patency (ACAPP)
Description
ACAPP defined as patency (open to blood flow)following the index study procedure until access thrombosis or a surgical intervention that excludes the treated lesion from the access circuit.
Time Frame
6 month Follow-Up
Title
Percent of Participants With Access Circuit Cumulative Patency (ACCP or Secondary Patency)
Description
ACCP defined as patency (open to blood flow) following the index study procedure until the access is surgically revised or abandoned because of the inability to treat the original lesion. Multiple treatments for occlusions to restore patency are compatible with ACCP.
Time Frame
6 month Follow-Up
Title
Percent of Participants With Binary Restenosis
Description
Binary restenosis defined as lesions with greater than or equal to 50% diameter stenosis of the treatment area (calculated by a core lab).
Time Frame
6 month Follow-Up
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or female patients between 18 to 90 years of age whose hemodialysis access was a synthetic AV access graft located in an arm.
Angiographic evidence of one or more stenoses, 7 cm or less in length and greater than or equal to 50%, at the graft-vein anastomosis of a synthetic AV access graft. The entire lesion must have been located within 7 cm of the anastomosis such that approximately 1 cm of the IMPRA/Bard Device must have extended into non-diseased vein and approximately 1 cm, but no more than 2 cm, of the IMPRA/Bard Device will be extended into non-diseased AV graft.
Clinical evidence of a hemodynamically significant stenosis.
Percutaneous endovascular therapy for the identified lesion was the best treatment choice in the opinion of the investigator.
Patients must have been able to understand and provide informed consent.
Patients whose synthetic AV access grafts had been implanted greater than 30 days and had undergone 1 or more successful hemodialysis sessions.
During primary balloon angioplasty, full expansion of an appropriately sized angioplasty balloon, in the operator's judgment, must have been achieved.
Exclusion Criteria:
Concomitant disease (e.g., terminal cancer) or other medical condition that was likely to result in death of the patient within 6 months of the time of implantation.
Stenoses that had a corresponding thrombosis treated within 7 days.
The presence of a second lesion in the access circuit less than or equal to 3 cm from the edges of the primary lesion that was treated within 30 days or that was greater than or equal to 30%. Access circuit was defined as the area from the AV access graft arterial anastomosis to the superior vena cava-right atrial junction.
The presence of a second lesion in the access circuit greater than 3 cm from the edges of the primary lesion that was greater than or equal to 30%. Second lesions that were greater than or equal to 30% must have been treated prior to patient inclusion to reduce the percent stenosis to less than 30%.
Patients who were unwilling or unable to return for follow-up visits or patients with whom follow-up visits may have been unreliable.
Patients who had a stent placed at the target lesion site.
Patients with a blood coagulative disorder or sepsis.
Patients in which the IMPRA/Bard Device would have been required to cross an angle (between the inflow vein and synthetic AV access graft) that was greater than 90 degrees.
Patients in which the IMPRA/Bard Device would have been required to be deployed fully across the elbow joint, which is identified radiographically by a combination of the humeroulnar joint and the humeroradial joint.
Patients with a contraindication to the use of contrast media.
Patients whose AV access graft was infected.
Patients who were currently or were scheduled to enroll in other investigations that conflicted with follow-up testing or confounds data in this trial.
Procedural use of another investigational device.
Patients who were pregnant.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Ciavarella, MD
Organizational Affiliation
C. R. Bard
Official's Role
Study Director
Facility Information:
Facility Name
New York Presbyterian Hospital/Columbia
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
20147715
Citation
Haskal ZJ, Trerotola S, Dolmatch B, Schuman E, Altman S, Mietling S, Berman S, McLennan G, Trimmer C, Ross J, Vesely T. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010 Feb 11;362(6):494-503. doi: 10.1056/NEJMoa0902045.
Results Reference
derived
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Pivotal Study for the FLAIR Endovascular Stent Graft
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