Registry of First-line Treatments in Patients With Critical Limb Ischemia

NCT ID: NCT01877252

Last Updated: 2014-11-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

1200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2013-01-31

Study Completion Date

2014-09-30

Brief Summary

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The principal research question is which treatment modality between open surgical, endovascular and conservative therapy is the most effective in terms of limb salvage, survival and reinterventions in patients with critical limb ischemia

Detailed Description

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The target population consists of patients suffering from critical limb ischemia (CLI) lasting more than 2 weeks. CLI is defined as rest pain or tissue loss (Fontaine stages III-IV or Rutherford classes 4 to 6) and/or ankle-brachial index \< 0.40. Patient with acute limb-threatening ischemia, bone fractures in the relevant areas, nonatherosclerotic disease (e.g. arteriitis) and documented hypercoagulable diseases will be excluded from this study. There will be no experimental or control groups. The comparison groups will be:

Group 1: Best endovascular treatment (angioplasty +/- stent) Group 2: Best surgical treatment \[bypass (vein or prosthetic)\] Group 3: Femoral artery patchplasty +/- profundoplasty (+/- endovascular treatment) Group 4: Best conservative treatment

The proposed sample size amounts to 1200 patients.

To be assessed for eligibility (n=1200) To be allocated to trial (n=1000) To be analysed (n=900)

In CRITISCH registry, randomization or blinding is not feasible, because optimized standard care will be performed as established at each participating centre (best medical treatment). Data storage, validation, monitoring, update, backup and analysis will be performed centrally following established procedures. Web-based software will be used to develop a data model representing the data structure. The data validation will include standard data validation techniques such as the manual review of selected variables and the routine check of missing and outlying data points. Regional staff will be instructed and supervised by study nurse, who will perform the study monitoring. Assessment of relevant prognostic factors during the statistical analysis will prevent biased results due to the non-randomized design and the potential structural inequality.

Conditions

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Critical Limb Ischemia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Endovascular treatment

Angioplasty +/- stent

Endovascular revascularization

Intervention Type PROCEDURE

Open treatment

Bypass (vein or prosthetic)

Surgical revascularization

Intervention Type PROCEDURE

Patchplasty/Hybrid treatment

Femoral artery patchplasty +/- profundoplasty +/- endovascular treatment

Surgical revascularization

Intervention Type PROCEDURE

Endovascular revascularization

Intervention Type PROCEDURE

Conservative treatment

no vascular intervention

No vascular intervention

Intervention Type OTHER

Interventions

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Surgical revascularization

Intervention Type PROCEDURE

Endovascular revascularization

Intervention Type PROCEDURE

No vascular intervention

Intervention Type OTHER

Other Intervention Names

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Vein PTFE Dacron Femoral artery patchplasty Profunda patchplasty Balloon angioplasty Stent Drug-eluting balloon Drug-eluting stent Lysis Major amputation Minor amputation Sympatholysis Conservative treatment

Eligibility Criteria

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Inclusion Criteria

* Rest pain or tissue loss (Fontaine stages III-IV or Rutherford classes 4 to 6) and/or ankle-brachial index \< 0.40

Exclusion Criteria

* Acute limb-threatening ischemia
* Bone fractures in the relevant areas
* Non-atherosclerotic disease (e.g. arteriitis)
* Documented hypercoagulable diseases
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Deutsches Institut für Gefäßmedizinische Gesundheitsforschung gGmbH (DIGG)

UNKNOWN

Sponsor Role collaborator

Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin

UNKNOWN

Sponsor Role collaborator

St. Franziskus Hospital

OTHER

Sponsor Role lead

Responsible Party

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Dr. Theodosios Bisdas

Dr. med.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of Vascular Surgery, St. Franziskus Hospital

Münster, , Germany

Site Status

Countries

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Germany

References

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Setacci C, de Donato G, Teraa M, Moll FL, Ricco JB, Becker F, Robert-Ebadi H, Cao P, Eckstein HH, De Rango P, Diehm N, Schmidli J, Dick F, Davies AH, Lepantalo M, Apelqvist J. Chapter IV: Treatment of critical limb ischaemia. Eur J Vasc Endovasc Surg. 2011 Dec;42 Suppl 2:S43-59. doi: 10.1016/S1078-5884(11)60014-2.

Reference Type BACKGROUND
PMID: 22172473 (View on PubMed)

Becker F, Robert-Ebadi H, Ricco JB, Setacci C, Cao P, de Donato G, Eckstein HH, De Rango P, Diehm N, Schmidli J, Teraa M, Moll FL, Dick F, Davies AH, Lepantalo M, Apelqvist J. Chapter I: Definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011 Dec;42 Suppl 2:S4-12. doi: 10.1016/S1078-5884(11)60009-9.

Reference Type BACKGROUND
PMID: 22172472 (View on PubMed)

Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005 Dec 3;366(9501):1925-34. doi: 10.1016/S0140-6736(05)67704-5.

Reference Type BACKGROUND
PMID: 16325694 (View on PubMed)

Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010 May;51(5 Suppl):5S-17S. doi: 10.1016/j.jvs.2010.01.073.

Reference Type BACKGROUND
PMID: 20435258 (View on PubMed)

Conte MS, Geraghty PJ, Bradbury AW, Hevelone ND, Lipsitz SR, Moneta GL, Nehler MR, Powell RJ, Sidawy AN. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009 Dec;50(6):1462-73.e1-3. doi: 10.1016/j.jvs.2009.09.044. Epub 2009 Nov 7.

Reference Type BACKGROUND
PMID: 19897335 (View on PubMed)

Stavroulakis K, Borowski M, Torsello G, Bisdas T; CRITISCH Collaborators. One-Year Results of First-Line Treatment Strategies in Patients With Critical Limb Ischemia (CRITISCH Registry). J Endovasc Ther. 2018 Jun;25(3):320-329. doi: 10.1177/1526602818771383. Epub 2018 Apr 26.

Reference Type DERIVED
PMID: 29968501 (View on PubMed)

Meyer A, Fiessler C, Stavroulakis K, Torsello G, Bisdas T, Lang W; CRITISCH collaborators. Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function. J Vasc Surg. 2018 Sep;68(3):822-829.e1. doi: 10.1016/j.jvs.2017.12.048. Epub 2018 Mar 26.

Reference Type DERIVED
PMID: 29598891 (View on PubMed)

Stavroulakis K, Borowski M, Torsello G, Bisdas T; CRITISCH collaborators. Association between statin therapy and amputation-free survival in patients with critical limb ischemia in the CRITISCH registry. J Vasc Surg. 2017 Nov;66(5):1534-1542. doi: 10.1016/j.jvs.2017.05.115. Epub 2017 Aug 12.

Reference Type DERIVED
PMID: 28807382 (View on PubMed)

Uhl C, Steinbauer M, Torsello G, Bisdas T; The CRITISCH collaborators. Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia. J Endovasc Ther. 2017 Aug 1;24(4):471-477. doi: 10.1177/1526602817711424. Epub 2017 Jun 5.

Reference Type DERIVED
PMID: 28578624 (View on PubMed)

Bisdas T, Borowski M, Stavroulakis K, Torsello G; CRITISCH Collaborators. Endovascular Therapy Versus Bypass Surgery as First-Line Treatment Strategies for Critical Limb Ischemia: Results of the Interim Analysis of the CRITISCH Registry. JACC Cardiovasc Interv. 2016 Dec 26;9(24):2557-2565. doi: 10.1016/j.jcin.2016.09.039.

Reference Type DERIVED
PMID: 28007205 (View on PubMed)

Meyer A, Lang W, Borowski M, Torsello G, Bisdas T; CRITISCH collaborators. In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization. J Vasc Surg. 2016 Apr;63(4):966-73. doi: 10.1016/j.jvs.2015.10.009. Epub 2016 Feb 1.

Reference Type DERIVED
PMID: 26843355 (View on PubMed)

Bisdas T, Borowski M, Torsello G; First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) Collaborators. Current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg. 2015 Oct;62(4):965-973.e3. doi: 10.1016/j.jvs.2015.04.441. Epub 2015 Jul 14.

Reference Type DERIVED
PMID: 26187290 (View on PubMed)

Related Links

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http://www.gefaesschirurgie.de

German Society for Vascular Surgery and Medicine

Other Identifiers

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CRITISCH132105

Identifier Type: -

Identifier Source: org_study_id