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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT01500668
Other study ID # SHEBA-11-9023-AH-CTIL
Secondary ID 9023-11-SMC
Status Recruiting
Phase Phase 4
First received December 22, 2011
Last updated January 3, 2012
Start date January 2012
Est. completion date December 2013

Study information

Verified date January 2012
Source Sheba Medical Center
Contact Amir Herman, MD, PhD
Phone 972-52-2655026
Email amirherm@gmail.com
Is FDA regulated No
Health authority Israel: Ethics Commission
Study type Interventional

Clinical Trial Summary

Patients in the intensive care unit (ICU) often require blood pressure support of vasoactive drugs such as amines. Finger necrosis (so called "blue toe syndrome") is a well documented phenomena with incidence reaching as high as 60% in patients receiving vasopressin. Botulinum toxin is a known muscle relaxant used for a variety of medical application. Recently, several reports have demonstrated its effect in vasospastic disorders. It has also been in mice that when administered locally it has a local vasodilatory effect. The goal of this experiment is to compare the effect of Botulinum Toxin administered locally on amine induced finger necrosis.


Recruitment information / eligibility

Status Recruiting
Enrollment 20
Est. completion date December 2013
Est. primary completion date December 2013
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Patients treated with vasoactive drugs (amines) and have finger/toe necrosis

Exclusion Criteria:

- Sensitivity to drug (Botox) ingredients.

- Active local limb infection

- ICU admission due to botulism

- Chronic muscular weakness disease, e.g., Myasthenia gravis, ALS

- Age lower than 18

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Outcomes Assessor), Primary Purpose: Treatment


Related Conditions & MeSH terms

  • Catocholamine Induced Finger Necrosis
  • Necrosis

Intervention

Drug:
Botox
Injection of 200 units of Botulinum Toxin A (BOTOX) to a treated limb. Each limb will be divided to two levels - arterial arch and digital arteries (near MCP/MTP) levels. In each level 100 units of Botox will be injected in 6 injection points in the proximity of the arteries.
Placebo
Injection of 0.5cc of normal saline (0.9% NaCl) to each injection site as in the Active drug arm.

Locations

Country Name City State
Israel Sheba Medical Center Tel-Hashomer

Sponsors (1)

Lead Sponsor Collaborator
Sheba Medical Center

Country where clinical trial is conducted

Israel, 

References & Publications (6)

Clemens MW, Higgins JP, Wilgis EF. Prevention of anastomotic thrombosis by botulinum toxin a in an animal model. Plast Reconstr Surg. 2009 Jan;123(1):64-70. doi: 10.1097/PRS.0b013e3181904c31. — View Citation

Dünser MW, Mayr AJ, Tür A, Pajk W, Barbara F, Knotzer H, Ulmer H, Hasibeder WR. Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med. 2003 May;31(5):1394-8. — View Citation

Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud's phenomenon. J Hand Surg Am. 2009 Mar;34(3):446-52. doi: 10.1016/j.jhsa.2008.11.026. — View Citation

Golbranson FL, Lurie L, Vance RM, Vandell RF. Multiple extremity amputations in hypotensive patients treated with dopamine. JAMA. 1980 Mar 21;243(11):1145-6. — View Citation

Janz BA, Thomas PR, Fanua SP, Dunn RE, Wilgis EF, Means KR Jr. Prevention of anastomotic thrombosis by botulinum toxin B after acute injury in a rat model. J Hand Surg Am. 2011 Oct;36(10):1585-91. doi: 10.1016/j.jhsa.2011.07.008. Epub 2011 Aug 19. — View Citation

Van Beek AL, Lim PK, Gear AJ, Pritzker MR. Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg. 2007 Jan;119(1):217-26. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary index of Toe and Finger Ischemia (iTFI) Score including:
O2 peripheral saturation monitoring Bleeding Capillary refilling Limb temperature Limb discoloration
three months after drug administration No
Secondary Amputation Amputations performed - fingers, toe and limb - height and number of amputations Three months after drug administration No
Secondary Patients survival Survival Three months after drug administration Yes