Vascular Graft Anastomotic Stenosis Clinical Trial
Official title:
A Prospective, Multicenter, Randomized, Controlled Trial for Comparison of Drug-coated Balloon Versus Conventional Balloon Angioplasty in Venous Anastomotic Stenosis of Hemodialysis Graft
To evaluate the role of DCB angioplasty for venous anastomotic stenosis of hemodialysis graft, investigators would like to perform randomized study comparing the results of drug- coated balloon angioplasty with conventional balloon angioplasty in the treatment in venous anastomotic stenosis of AVG in terms of patency.
Study Procedure The Interventional angiographic suit will follow the standard hemodialysis
related interventional procedure for PTA. Fistulogram will be performed prior to PTA. All
enrolled patients should undergo 3 and 6-month follow-up fistulogram and information will be
collected and recorded on the treated study vessel and pictures through angiographic image.
These data will be recorded on clinical recording form using an excel program.
1. Pretreatment evaluation 1.1 All procedures will be performed after obtaining written
informed consent from patients. No specific pre-treatment regimen will be needed.
1.2 After sterile preparation and draping, percutaneous access will be gained in an
appropriately chosen hemodialysis graft after application of local anesthesia.
Diagnostic fistulogram was performed to identify and evaluate the target lesion and any
possible secondary lesions. In case of thrombotic occlusion of AVG, diagnostic
fistulogram will be done after successful aspiration thrombectomy though a sheath.
1.3 All lesions were characterized by location, length, and degree of stenosis. The
degree of stenoses was evaluated in two orthogonal planes, and the greatest degree of
stenoses was used for subsequent anatomic measurements. Anatomic measurements were made
with use of a calibrated reference marker or software within the angiographic imaging
system. The reference vessel was defined as an adjacent segment of normal vein or graft
located adjacent to the target lesion. The degree of stenosis was reported as the
maximum diameter reduction compared with the reference vessel diameter.
2. PTA in venous anastomosis of AVG 2.1 Vascular sheaths will be used in all cases. 2.2
Balloon diameter will be chosen at the operator's discretion, generally starting with a
balloon 10% oversized compared with the adjacent normal vein or graft in both groups
(Reference Vessel Diameter: RVD).
2.3 Balloon length will be also chosen at the discretion of the operator: In general,
4-cm- or 6cm-long balloons can be used for some long lesions.
2.4 If patient requested the sedation, conscious sedation can be done. 2.5 After
crossing the stenosis with a guide wire, the conventional balloon catheter was
appropriately positioned across the lesion under fluoroscopic guidance. With the use of
an inflation device with a pressure gauge, the balloon catheter was gradually inflated
until the stenosis was eliminated.
2.6 Randomization will be assigned after successful conventional balloon angioplasty in
venous anastomotic stenosis of AVG. After conventional angioplasty, patients will be
randomly assigned to undergo DEB angioplasty or to receive conventional balloon
angioplasty for 3 minutes (upto norminal pressure).
2.7 If the patient will be randomly assigned to the DEB group, an In.Pact® Drug-eluting
balloon catheter (6, 7mm in diameter, ≦6cm in length) will be used in addition to
conventional balloon angioplasty. A balloon diameter and length will be equal to that
used in the conventional balloon angioplasty group.
3. Procedure Materials PRODUCT SIZE LENGTHS Drug Eluting balloon In.Pact® 6,7mm 4, 6cm
Conventional balloon Various conventional balloon catheter 6,7mm 4, 6cm
4. Follow-up
- All patients will be followed after PTA. When patients visit hemodialysis unit 3
and 6 months after PTA, the patient's record will be updated.
- All patients that visit hemodialysis unit will be brought to angiographic suit to
undergo follow-up fistulogram and evaluate the re-stenosis.
- Clinical follow-up will be performed in hemodialysis unit, including checking the
status of hemodialysis using a those circuits and general work-up.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment