PICO Above Incisions After Vascular Surgery

NCT ID: NCT01913132

Last Updated: 2024-11-29

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

RECRUITING

Clinical Phase

NA

Total Enrollment

644 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-11-30

Study Completion Date

2026-12-31

Brief Summary

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The wound infection rate in the groin after vascular surgery has been denoted to be high since the wound surveillance register started in 2005. The current wound infection rate based on a validation study was 22.9% (24/105 patients with groin incision(s) between 1 March to 30 June in 2012). This randomized controlled trial aims to evaluate if negative pressure wound therapy on closed inguinal incisions (INPWT) after vascular surgical procedures can reduce the risk for surgical site infections and other wound complications.

Detailed Description

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As published in the study´s rational and design paper (DOI: 10.4236/ss.2015.612080), we conducted a reanalysis of the material that the original power calculation was based on and included elective cases only which led to a slightly different number of cases needed. Furthermore, it became clear that there were big differences in the infection rates of EVAR (endovascular aortic repair) and open vascular procedures and therefore the need to split the study into two arms, an EVAR arm and an OPEN arm.

To prove a significant effect of the treatment intervention in the EVAR arm with a wound infection rate reduction from previously 4.4% to 1%, 80% power, 5% significance level and Including a margin for loss to follow-up, the EVAR arm requires 497 inguinal incisions. Assuming a surgical site infection rate reduction from 30% to 10% in the OPEN arm of the study, 80% power and 5% significance level, a total of 147 inguinal incisions is required.

We conducted an unannounced interim analysis for a conference presentation that was conducted by the study's principal investigators Stefan Acosta and Julien Hasselmann. Staff in charge of the day-to-day activities of the trial were not involved or actively informed of this. We believe that using an objective wound assessment tool (ASEPSIS score) minimizes any potential bias associated with the interim analysis.

Since the vascular center Malmö has started using closure-devices for almost all EVAR cases and thereby creating virtually no wounds to assess, we have started a multi center extension of the EVAR arm to Örebro University Hospital to be able to include the outstanding cases.

FUNDING

The trial has been funded by public Swedish funds stemming from the Southmost region in Sweden (Region Skåne), the Skåne University Hospital and the Hulda Almroth foundation since 2015 and adds up to a total of 2.81 million SEK (about 311,000 USD). In addition the research group received an unrestricted unconditional research grant of 15,550 USD and a donation of 100 PICO dressing kits from Smith and Nephew in 2013.

ALF (Agreement on medical education and research) funding has been granted for the time period 2019 - 2022 but has not yet been defined monetarily.

Conditions

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Wound Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

2 study subgroups: 1) OPEN arm for open procedures 2) EVAR arm for endovascular aortic repair
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Caregivers

Study Groups

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Standard wound dressing OPEN

Standard wound dressing

Group Type NO_INTERVENTION

No interventions assigned to this group

PICO dressing OPEN

Negative pressure wound therapy with PICO (Smith \& Nephew)

Group Type EXPERIMENTAL

Negative pressure wound therapy with PICO (Smith & Nephew)

Intervention Type DEVICE

Negative wound pressure therapy

Standard dressing EVAR

Standard wound dressing

Group Type NO_INTERVENTION

No interventions assigned to this group

PICO dressing EVAR

Negative pressure wound therapy with PICO (Smith \& Nephew)

Group Type EXPERIMENTAL

Negative pressure wound therapy with PICO (Smith & Nephew)

Intervention Type DEVICE

Negative wound pressure therapy

Interventions

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Negative pressure wound therapy with PICO (Smith & Nephew)

Negative wound pressure therapy

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients 18 years of age and above
* Elective vascular surgery
* Inguinal incision (transverse or longitudinal)
* Capable of understanding the study information and giving written informed consent

Exclusion Criteria

* Emergency surgery
* Ongoing infection in inguinal area
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Stefan Acosta

OTHER

Sponsor Role lead

Responsible Party

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Stefan Acosta

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Stefan Acosta, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Vascular Centre, Malmö, Skåne University Hospital

Julien Hasselmann, MD

Role: PRINCIPAL_INVESTIGATOR

Vascular Centre, Malmö, Skåne University Hospital

Locations

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Vascular Centre, Malmö, Skåne University Hospital

Malmo, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Stefan Acosta, MD PhD

Role: CONTACT

+4640331000

Facility Contacts

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Stefan Acosta, MD PhD

Role: primary

References

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Hasselmann J, Bjork J, Svensson-Bjork R, Acosta S. Inguinal Vascular Surgical Wound Protection by Incisional Negative Pressure Wound Therapy: A Randomized Controlled Trial-INVIPS Trial. Ann Surg. 2020 Jan;271(1):48-53. doi: 10.1097/SLA.0000000000003364.

Reference Type RESULT
PMID: 31283565 (View on PubMed)

Correia RM, Nakano LC, Vasconcelos V, Cristino MA, Flumignan RL. Prevention of infection in peripheral arterial reconstruction of the lower limb. Cochrane Database Syst Rev. 2025 Oct 29;10:CD015022. doi: 10.1002/14651858.CD015022.pub2.

Reference Type DERIVED
PMID: 41159585 (View on PubMed)

Svensson-Bjork R, Hasselmann J, Asciutto G, Zarrouk M, Bjork J, Bilos L, Pirouzram A, Acosta S. Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR-A Randomized Trial. World J Surg. 2022 Dec;46(12):3111-3120. doi: 10.1007/s00268-022-06740-5. Epub 2022 Oct 14.

Reference Type DERIVED
PMID: 36241857 (View on PubMed)

Rezk F, Astrand H, Acosta S. Incisional negative pressure wound therapy for the prevention of surgical site infection after open lower limb revascularization - Rationale and design of a multi-center randomized controlled trial. Contemp Clin Trials Commun. 2019 Oct 14;16:100469. doi: 10.1016/j.conctc.2019.100469. eCollection 2019 Dec.

Reference Type DERIVED
PMID: 31701043 (View on PubMed)

Related Links

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Other Identifiers

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Dnr 2013/322

Identifier Type: -

Identifier Source: org_study_id