Trial Outcomes & Findings for Comparison of the Human Acellular Vessel (HAV) With ePTFE Grafts as Conduits for Hemodialysis (NCT NCT02644941)

NCT ID: NCT02644941

Last Updated: 2025-03-30

Results Overview

1. Defined as 'the interval from the time of access placement until access abandonment', i.e., patent with or without interventions (Sidawy et al. 2002). 2. "Abandonment" defined as no remaining segment of the study conduit was incorporated into the vascular access circuit used for dialysis (conversely, if some portion of the study conduit was still being used for dialysis it was not considered abandoned).

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

355 participants

Primary outcome timeframe

12 months post-implantation

Results posted on

2025-03-30

Participant Flow

This was a large multicenter comparative study conducted at 37 centers in 6 countries to compare the HAV and ePTFE.

Participant milestones

Participant milestones
Measure
Human Acellular Vessel (HAV)
HAV-tissue-engineered vascular conduit (6mm diameter).
ePTFE
The comparator is one two commercially available 6 mm ePTFE grafts (Bard Impra® or Gore PROPATEN®)
18 Months
STARTED
177
178
18 Months
COMPLETED
128
126
18 Months
NOT COMPLETED
49
52
24 Months
STARTED
177
178
24 Months
COMPLETED
108
106
24 Months
NOT COMPLETED
69
72
60 Months
STARTED
177
178
60 Months
COMPLETED
78
80
60 Months
NOT COMPLETED
99
98

Reasons for withdrawal

Reasons for withdrawal
Measure
Human Acellular Vessel (HAV)
HAV-tissue-engineered vascular conduit (6mm diameter).
ePTFE
The comparator is one two commercially available 6 mm ePTFE grafts (Bard Impra® or Gore PROPATEN®)
18 Months
Subjects lost graft during the study up to the data cut-off
49
52

Baseline Characteristics

Comparison of the Human Acellular Vessel (HAV) With ePTFE Grafts as Conduits for Hemodialysis

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
The comparator is one two commercially available 6 mm ePTFE grafts (Bard Impra® or Gore PROPATEN®)
Total
n=355 Participants
Total of all reporting groups
Age, Customized
18-21 years
0 Age range of participants
n=93 Participants
1 Age range of participants
n=4 Participants
1 Age range of participants
n=27 Participants
Age, Customized
22-44 years
21 Age range of participants
n=93 Participants
22 Age range of participants
n=4 Participants
43 Age range of participants
n=27 Participants
Age, Customized
45-64 years
69 Age range of participants
n=93 Participants
78 Age range of participants
n=4 Participants
147 Age range of participants
n=27 Participants
Age, Customized
65-74 years
57 Age range of participants
n=93 Participants
50 Age range of participants
n=4 Participants
107 Age range of participants
n=27 Participants
Age, Customized
>/= 75 years
30 Age range of participants
n=93 Participants
27 Age range of participants
n=4 Participants
57 Age range of participants
n=27 Participants
Sex: Female, Male
Female
89 Participants
n=93 Participants
90 Participants
n=4 Participants
179 Participants
n=27 Participants
Sex: Female, Male
Male
88 Participants
n=93 Participants
88 Participants
n=4 Participants
176 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
26 Participants
n=93 Participants
20 Participants
n=4 Participants
46 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
129 Participants
n=93 Participants
127 Participants
n=4 Participants
256 Participants
n=27 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
22 Participants
n=93 Participants
31 Participants
n=4 Participants
53 Participants
n=27 Participants
Race/Ethnicity, Customized
White
123 Participants
n=93 Participants
116 Participants
n=4 Participants
239 Participants
n=27 Participants
Race/Ethnicity, Customized
Black or African American
44 Participants
n=93 Participants
49 Participants
n=4 Participants
93 Participants
n=27 Participants
Race/Ethnicity, Customized
Asian
4 Participants
n=93 Participants
6 Participants
n=4 Participants
10 Participants
n=27 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
4 Participants
n=93 Participants
3 Participants
n=4 Participants
7 Participants
n=27 Participants
Race/Ethnicity, Customized
Other
2 Participants
n=93 Participants
4 Participants
n=4 Participants
6 Participants
n=27 Participants
Region of Enrollment
United States
103 participants
n=93 Participants
103 participants
n=4 Participants
206 participants
n=27 Participants
Region of Enrollment
Europe
62 participants
n=93 Participants
61 participants
n=4 Participants
123 participants
n=27 Participants
Region of Enrollment
Israel
12 participants
n=93 Participants
14 participants
n=4 Participants
26 participants
n=27 Participants

PRIMARY outcome

Timeframe: 12 months post-implantation

1. Defined as 'the interval from the time of access placement until access abandonment', i.e., patent with or without interventions (Sidawy et al. 2002). 2. "Abandonment" defined as no remaining segment of the study conduit was incorporated into the vascular access circuit used for dialysis (conversely, if some portion of the study conduit was still being used for dialysis it was not considered abandoned).

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Secondary Patency
29 Participants
34 Participants

PRIMARY outcome

Timeframe: 18 months post-implantation

1. Defined as 'the interval from the time of access placement until access abandonment', i.e., patent with or without interventions (Sidawy et al. 2002). 2. "Abandonment" defined as no remaining segment of the study conduit was incorporated into the vascular access circuit used for dialysis (conversely, if some portion of the study conduit was still being used for dialysis it was not considered abandoned).

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Secondary Patency
41 Participants
37 Participants

PRIMARY outcome

Timeframe: 24 months post-implantation

1. Defined as 'the interval from the time of access placement until access abandonment', i.e., patent with or without interventions (Sidawy et al. 2002). 2. "Abandonment" defined as no remaining segment of the study conduit was incorporated into the vascular access circuit used for dialysis (conversely, if some portion of the study conduit was still being used for dialysis it was not considered abandoned).

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Secondary Patency
48 Participants
41 Participants

SECONDARY outcome

Timeframe: 12 months post-implantation

Use of duplex ultrasonography to assess study conduit patency. Loss of primary patency occurs when any intervention is performed on the conduit regardless of whether the conduit thrombosed.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Primary Patency
118 Participants
78 Participants

SECONDARY outcome

Timeframe: 18 months post-implantation

Use of duplex ultrasonography to assess study conduit patency. Loss of primary patency occurs when any intervention is performed on the conduit regardless of whether the conduit thrombosed.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Primary Patency
146 Participants
111 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

Use of duplex ultrasonography to assess study conduit patency. Loss of primary patency occurs when any intervention is performed on the conduit regardless of whether the conduit thrombosed.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Primary Patency
132 Participants
104 Participants

SECONDARY outcome

Timeframe: 60 months post-implantation

Duplex ultrasound was used to assess study conduit patency. Loss of primary patency occurs when any intervention is performed on the conduit regardless of whether the conduit thrombosed.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With Loss of Primary Patency
146 Participants
121 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

No remaining segment of the study conduit is incorporated into the vascular access circuit used for dialysis.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Study Conduit Abandonment
57 Participants
44 Participants

SECONDARY outcome

Timeframe: 60 months post-implantation

No remaining segment of the study conduit is incorporated into the vascular access circuit used for dialysis.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Study Conduit Abandonment
69 Participants
53 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

Adjudicated using the standard definition of access-related infections (CDC; 2013).

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Rate of Adjudicated Study Conduit Access Related Infections
0.93 Events per 100 Person-Years
4.54 Events per 100 Person-Years

SECONDARY outcome

Timeframe: 60 months post-implantation

Using Dialysis Event Surveillance Manual: CDC; 2013.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Access-related Infections
17 Access related infection events
27 Access related infection events

SECONDARY outcome

Timeframe: 24 months post-implantation

Rate of intervention defined as the number of interventions per participant per year while conduit is patent (i.e., has not been abandoned). Number of successful interventions to achieve/maintain Secondary Patency.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Participants With at Least 1 Intervention Required to Achieve/Maintain Secondary Patency
146 Participants
116 Participants

SECONDARY outcome

Timeframe: 60 months post-implantation

Population: Non-oversized ballon use (no greater than 6 mm)

Total number of interventions performed by treatment group stratified by any use of balloon size no \> 6 millimeters.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Total Interventions Performed to Maintain Secondary Patency (Ballon Size Not > 6 Millimeters)
2.7 Interventions per participant
Standard Deviation 3.68
2.7 Interventions per participant
Standard Deviation 3.77

SECONDARY outcome

Timeframe: 60 months post-implantation

Population: Oversized ballon use (greater than 6 mm)

Total number of interventions performed by treatment group stratified by any use of balloon size greater than 6 millimeters.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Total Interventions Performed to Maintain Secondary Patency (Balloon Size > 6 Millimeters)
7.3 Interventions per participant
Standard Deviation 5.74
2.7 Interventions per participant
Standard Deviation 3.77

SECONDARY outcome

Timeframe: 24 months post-implantation

Total number of thrombosis events (per each treatment group) that required an intervention to maintain the functionality of patent access

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Thrombosis of Study Access That Required Intervention
361 Thrombosis events requiring intervention
170 Thrombosis events requiring intervention

SECONDARY outcome

Timeframe: 60 months post-implantation

Total number of thrombosis events (per each treatment group) that required an intervention to maintain the functionality of patent access

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Thrombosis of Study Access That Required Intervention
409 Thrombosis events requiring intervention
205 Thrombosis events requiring intervention

SECONDARY outcome

Timeframe: 2 to 18 Months post-implantation

Population: Female and Male

Dialysis efficiency as assessed by spKt/Vurea (obtained from dialysis unit for a subset of subjects) will be summarized descriptively. The most recent available data prior to the study visits will be used for the analysis. Twenty sites provided at least 1 spKt/Vurea measurement. spKt/Vurea: measure of dialysis adequacy for a single hemodialysis treatment using the single pooled method.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=69 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=72 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Dialysis Efficiency as Measured by spKt/Vurea (Subset of Subjects)
1.61 unitless
Standard Deviation 0.551
1.67 unitless
Standard Deviation 0.445

SECONDARY outcome

Timeframe: 24 months post-implantation

Severity Assessment Standard 1. Mild: Events require minimal or no treatment and do not interfere with the subject's daily activities. 2. Moderate: Events result in a low level of inconvenience or concern with the therapeutic measures. May cause some interference with functioning. 3. Severe: Events interrupt a subject's usual daily activity and may require systemic drug therapy or other treatment. Severe events are usually incapacitating. 4. Life-threatening: Any adverse event that places the subject or participant, in the view of the investigator, at immediate risk of death from the reaction as it occurred, i.e., it does not include a reaction that, had it occurred in a more severe form, might have caused death. 5. Death: Death related to Adverse Event.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Severity of Adverse Events
Mild
8 Participants
9 Participants
Severity of Adverse Events
Moderate
39 Participants
55 Participants
Severity of Adverse Events
Severe
74 Participants
64 Participants
Severity of Adverse Events
Life-threatening
9 Participants
7 Participants
Severity of Adverse Events
Death
45 Participants
39 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

Collection of all Adverse Events beginning on Day 0 after implantation up to 2 years post implantation (Month 24).

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Number of Participants With at Least One Adverse Event
175 Participants
174 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

Assessed by ultrasound: at least a 50% increase over the 6 millimeter baseline

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
True Aneurysm Formation (Conduit Lumen Diameter >9 Millimeters)
19 Total number of aneurysms
11 Total number of aneurysms

SECONDARY outcome

Timeframe: 60 months post-implantation

Assessed by ultrasound: at least a 50% increase over the 6 millimeter baseline

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
True Aneurysm Formation (Conduit Lumen Diameter >9 Millimeters)
23 Total number of aneurysms
12 Total number of aneurysms

SECONDARY outcome

Timeframe: 24 months post-implantation

Use of duplex ultrasound to assess the diameter of the lumen mid-conduit. The outcome measures data represents the total number of pseudoaneurysms.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Pseudoaneurysm Formation
98 Pseudoaneurysms
47 Pseudoaneurysms

SECONDARY outcome

Timeframe: 60 months post-implantation

Use of duplex ultrasound to assess the diameter of the lumen mid-conduit. The outcome measures data represents the total number of pseudoaneurysms.

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Pseudoaneurysm Formation
113 Pseudoaneurysms
59 Pseudoaneurysms

SECONDARY outcome

Timeframe: 24 months post-implantation

Assessed by ultrasound

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Study Conduit Spontaneous Ruptures Due to Iatrogenic Injury
0 Ruptures d/t iatrogenic injury
0 Ruptures d/t iatrogenic injury

SECONDARY outcome

Timeframe: 60 months post-implantation

Assessed by ultrasound

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Study Conduit Spontaneous Ruptures Due to Iatrogenic Injury
0 Ruptures d/t iatrogenic injury
0 Ruptures d/t iatrogenic injury

SECONDARY outcome

Timeframe: 24 months post-implantation

Assessed by ultrasound

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Anastomotic Bleeding or Rupture
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 60 months post-implantation

Assessed by ultrasound

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Anastomotic Bleeding or Rupture
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 18 months post-implantation

Increase in Panel Reactive Antibody more than 20% (highly sensitized) from baseline

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Calculated Panel Reactive Antibody More Than 20% Change From Baseline
3 Participants
8 Participants

SECONDARY outcome

Timeframe: 24 months post-implantation

Increase in Panel Reactive Antibody more than 20% (highly sensitized) from baseline

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Calculated Panel Reactive Antibody More Than 20% Change From Baseline
2 Participants
10 Participants

SECONDARY outcome

Timeframe: 12 months post-implantation

Duplex ultrasonography: diameter of the mid-conduit lumen

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Mean Inner Diameter of Conduit (Millimeter)
6.20 Inner diameter (millimeter)
Standard Deviation 1.452
5.66 Inner diameter (millimeter)
Standard Deviation 1.601

SECONDARY outcome

Timeframe: 24 months post-implantation

Duplex ultrasonography: diameter of the mid-conduit lumen

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Mean Inner Diameter of Conduit (Millimeter)
6.02 Inner diameter (millimeter)
Standard Deviation 2.898
5.88 Inner diameter (millimeter)
Standard Deviation 2.209

SECONDARY outcome

Timeframe: 60 months post-implantation

Duplex ultrasonography: diameter of the mid-conduit lumen

Outcome measures

Outcome measures
Measure
Human Acellular Vessel (HAV)
n=177 Participants
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 Participants
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Mean Inner Diameter of Conduit (Millimeter)
6.19 Inner diameter (millimeter)
Standard Deviation 1.979
6.23 Inner diameter (millimeter)
Standard Deviation 1.131

Adverse Events

Human Acellular Vessel (HAV)

Serious events: 157 serious events
Other events: 176 other events
Deaths: 46 deaths

ePTFE

Serious events: 146 serious events
Other events: 176 other events
Deaths: 39 deaths

Serious adverse events

Serious adverse events
Measure
Human Acellular Vessel (HAV)
n=177 participants at risk
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 participants at risk
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Blood and lymphatic system disorders
Anemia
4.0%
7/177 • Number of events 9 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.6%
10/178 • Number of events 13 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Cardiac disorders
Cardiac arrest
3.4%
6/177 • Number of events 38 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.2%
11/178 • Number of events 32 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Cardiac disorders
Cardiac failure congestive
3.4%
6/177 • Number of events 38 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
4.5%
8/178 • Number of events 32 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Pneumonia
6.2%
11/177 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
10.1%
18/178 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Sepsis
7.3%
13/177 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Vascular access site infection
7.3%
13/177 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
10.1%
18/178 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site pseudoaneurysm
9.6%
17/177 • Number of events 99 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
2.8%
5/178 • Number of events 71 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site thrombosis
45.8%
81/177 • Number of events 99 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
32.0%
57/178 • Number of events 71 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Metabolism and nutrition disorders
Hyperkalemia
5.1%
9/177 • Number of events 21 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.1%
9/178 • Number of events 26 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Hypotension
5.6%
10/177 • Number of events 77 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
2.2%
4/178 • Number of events 69 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Vascular stenosis
29.9%
53/177 • Number of events 77 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
27.5%
49/178 • Number of events 69 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Venous stenosis
4.0%
7/177 • Number of events 78 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.1%
9/178 • Number of events 74 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.

Other adverse events

Other adverse events
Measure
Human Acellular Vessel (HAV)
n=177 participants at risk
HAV-tissue-engineered vascular conduit (6mm diameter)
ePTFE
n=178 participants at risk
One of two commercially available comparators (Bard Impra® and Gore PROPATEN®)
Blood and lymphatic system disorders
Anemia
10.7%
19/177 • Number of events 31 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
10.7%
19/178 • Number of events 30 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Gastrointestinal disorders
Abdominal pain
4.5%
8/177 • Number of events 51 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.6%
10/178 • Number of events 53 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Gastrointestinal disorders
Diarrhea
8.5%
15/177 • Number of events 51 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.6%
10/178 • Number of events 53 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Gastrointestinal disorders
Nausea
6.8%
12/177 • Number of events 51 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
9.6%
17/178 • Number of events 53 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Gastrointestinal disorders
Vomiting
7.3%
13/177 • Number of events 51 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 53 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
General disorders
Edema peripheral
5.1%
9/177 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
7.9%
14/178 • Number of events 81 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
General disorders
Implant site extravasation
6.2%
11/177 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.2%
11/178 • Number of events 81 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
General disorders
Peripheral swelling
7.3%
13/177 • Number of events 72 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
4.5%
8/178 • Number of events 81 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Pneumonia
10.2%
18/177 • Number of events 90 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
12.9%
23/178 • Number of events 105 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Sepsis
7.9%
14/177 • Number of events 90 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 105 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Upper respiratory infection
4.5%
8/177 • Number of events 90 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.2%
11/178 • Number of events 105 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Urinary tract infection
9.0%
16/177 • Number of events 90 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 105 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Infections and infestations
Vascular access site infection
9.6%
17/177 • Number of events 90 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
15.2%
27/178 • Number of events 105 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site hematoma
27.1%
48/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
20.8%
37/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site hemorrhage
24.3%
43/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
19.7%
35/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access edema
5.1%
9/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.1%
9/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site pain
7.3%
13/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
10.1%
18/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site pseudoaneurysm
42.4%
75/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
23.0%
41/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site swelling
15.8%
28/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
11.8%
21/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Injury, poisoning and procedural complications
Vascular access site thrombosis
70.1%
124/177 • Number of events 168 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
52.2%
93/178 • Number of events 150 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Metabolism and nutrition disorders
Fluid overload
6.8%
12/177 • Number of events 55 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.2%
11/178 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Metabolism and nutrition disorders
Hyperkalemia
14.1%
25/177 • Number of events 55 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
14.6%
26/178 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Metabolism and nutrition disorders
Hypoglycemia
3.4%
6/177 • Number of events 55 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 61 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Nervous system disorders
Hypoesthesia
4.5%
8/177 • Number of events 49 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
7.9%
14/178 • Number of events 56 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Respiratory, thoracic and mediastinal disorders
Dyspnea
8.5%
15/177 • Number of events 54 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.6%
10/178 • Number of events 38 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Aneurysm
10.7%
19/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Hypertension
5.1%
9/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
7.9%
14/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Hypotension
13.0%
23/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
6.7%
12/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Steal syndrome
10.7%
19/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
8.4%
15/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Subclavian vein stenosis
5.1%
9/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
5.1%
9/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Vascular stenosis
78.5%
139/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
69.1%
123/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
Vascular disorders
Venous stenosis
13.6%
24/177 • Number of events 156 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.
15.7%
28/178 • Number of events 144 • All study participants were followed to 24 months post-implantation at routine study visits regardless of patency status. After 24 months, participants with a patent study conduit were followed (while the study conduit remained patent) for up to 5 years (60 months) post-implantation at routine study visits.

Additional Information

Shamik Parikh, Chief Medical Officer

Humacyte Global Inc

Phone: 919-313-9633

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place