Continuous Suturing Versus Interrupted Clips for Brachiocephalic AV Fistula Creation

NCT ID: NCT03024372

Last Updated: 2018-07-06

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2017-12-31

Study Completion Date

2024-08-31

Brief Summary

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The purpose of this study is to investigate a promising strategy to improve maturation and patency rates following creation of AV fistulas and assess whether an anastomosis performed with Anastoclips (interrupted, nonpenetrating) would produce better maturation and/or patency than one performed with conventional suturing techniques.

Detailed Description

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This will be a single blind (patient and dialysis center), prospective, randomized trial conducted at a single center. The study intervention will be randomization between conventional sutured anastomosis (Control group) and use of Anastoclips (Treatment group), which provide an interrupted closure without intimal penetration.

Conditions

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Arteriovenous Fistula

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Conventional sutures

AV fistula creation with sutures

Group Type ACTIVE_COMPARATOR

AV Fistula creation with sutures

Intervention Type DEVICE

End-to-side anastomosis (of AV fistula) is to be constructed using sutures. The incision is to be irrigated and closed using Vicryl, Biosyn and skin glue.

Anastoclips

AV fistula creation with clips

Group Type ACTIVE_COMPARATOR

AV Fistula creation with clips

Intervention Type DEVICE

End-to-side anastomosis (of AV fistula) is to be constructed using clips. The incision is to be irrigated and closed using Vicryl, Biosyn and skin glue.

Interventions

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AV Fistula creation with sutures

End-to-side anastomosis (of AV fistula) is to be constructed using sutures. The incision is to be irrigated and closed using Vicryl, Biosyn and skin glue.

Intervention Type DEVICE

AV Fistula creation with clips

End-to-side anastomosis (of AV fistula) is to be constructed using clips. The incision is to be irrigated and closed using Vicryl, Biosyn and skin glue.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Requiring brachiocephalic fistula judged to be best option for access after vein mapping (Surgeons will be required to do 10 cases using Anastoclips prior to enrolling)
* Able to provide informed consent in English or Spanish
* Age 18 years or greater
* With estimated life expectancy of 2 years or more
* Able to comply with study procedures including all scheduled follow-up visits

Exclusion Criteria

* Unable to provide informed consent in English or Spanish
* Age \< 18 years
* With pacemaker, IACD, or other permanent obstructive device on that side (a temporary tunneled dialysis catheter is not an exclusion)
* Unable (or in surgeon's judgment a poor risk) to comply with study procedures and follow-up visits
* With estimated life expectancy of less than 2 years
* Females must be either:

* Of non-childbearing potential, which is defined as post-menopausal (at least 12 months without menses prior to Treatment Day) or documented surgically sterile or post hysterectomy (at least 1 month prior to Treatment Day)
* Or, of childbearing potential, in which case must have a negative urine pregnancy test at Treatment Day
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of South Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Karl Illig, MD

Role: PRINCIPAL_INVESTIGATOR

University of South Florida

Locations

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Tampa General Hospital

Tampa, Florida, United States

Site Status

University of South Florida - South Tampa Campus

Tampa, Florida, United States

Site Status

USF Health Carol and Frank Morsani Center for Advanced Healthcare

Tampa, Florida, United States

Site Status

Countries

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United States

References

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Haruguchi H, Nakagawa Y, Uchida Y, Sageshima J, Fuchinoue S, Agishi T. Clinical application of vascular closure staple clips for blood access surgery. ASAIO J. 1998 Sep-Oct;44(5):M562-4. doi: 10.1097/00002480-199809000-00050.

Reference Type BACKGROUND
PMID: 9804495 (View on PubMed)

Schild AF, Pruett CS, Newman MI, Raines J, Petersen F, Konkin T, Kim P, Dickson C, Kirsch WM. The utility of the VCS clip for creation of vascular access for hemodialysis: long-term results and intraoperative benefits. Cardiovasc Surg. 2001 Dec;9(6):526-30. doi: 10.1016/s0967-2109(01)00088-6.

Reference Type BACKGROUND
PMID: 11604333 (View on PubMed)

Cook JW, Schuman ES, Standage BA, Heinl P. Patency and flow characteristics using stapled vascular anastomoses in dialysis grafts. Am J Surg. 2001 Jan;181(1):24-7. doi: 10.1016/s0002-9610(00)00547-x.

Reference Type BACKGROUND
PMID: 11248171 (View on PubMed)

Cooper BZ, Flores L, Ramirez JA, Najjar JG, Abir F, Rayham R, Paladino L, Nguyen M, Panetta TF. Analysis of nonpenetrating clips versus sutures for arterial venous graft anastomosis. Ann Vasc Surg. 2001 Jan;15(1):7-12. doi: 10.1007/s100160010001.

Reference Type BACKGROUND
PMID: 11221948 (View on PubMed)

Zeebregts CJ. Randomized clinical trial of continuous sutures or non-penetrating clips for radiocephalic arteriovenous fistula (Br J Surg 2004; 91: 1438-1442). Br J Surg. 2005 May;92(5):654-5. doi: 10.1002/bjs.5063. No abstract available.

Reference Type BACKGROUND
PMID: 15852413 (View on PubMed)

Sukhatme VP. Vascular access stenosis: prospects for prevention and therapy. Kidney Int. 1996 Apr;49(4):1161-74. doi: 10.1038/ki.1996.167. No abstract available.

Reference Type BACKGROUND
PMID: 8691738 (View on PubMed)

Suresh K. An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011 Jan;4(1):8-11. doi: 10.4103/0974-1208.82352.

Reference Type BACKGROUND
PMID: 21772732 (View on PubMed)

Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, Miller A, Scher L, Trerotola S, Gregory RT, Rutherford RB, Kent KC. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002 Mar;35(3):603-10. doi: 10.1067/mva.2002.122025.

Reference Type BACKGROUND
PMID: 11877717 (View on PubMed)

Zhou XH, Melfi CA, Hui SL. Methods for comparison of cost data. Ann Intern Med. 1997 Oct 15;127(8 Pt 2):752-6. doi: 10.7326/0003-4819-127-8_part_2-199710151-00063.

Reference Type BACKGROUND
PMID: 9382393 (View on PubMed)

Shenoy S, Miller A, Petersen F, Kirsch WM, Konkin T, Kim P, Dickson C, Schild AF, Stewart L, Reyes M, Anton L, Woodward RS. A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. J Vasc Surg. 2003 Aug;38(2):229-35. doi: 10.1016/s0741-5214(03)00412-9.

Reference Type RESULT
PMID: 12891102 (View on PubMed)

Nguyen KP, Teruya T, Alabi O, Sheng N, Bianchi C, Chiriano J, Dehom S, Abou-Zamzam A. Comparison of Nonpenetrating Titanium Clips versus Continuous Polypropylene Suture in Dialysis Access Creation. Ann Vasc Surg. 2016 Apr;32:15-9. doi: 10.1016/j.avsg.2015.11.008. Epub 2016 Jan 22.

Reference Type RESULT
PMID: 26806237 (View on PubMed)

Aitken E, Jeans E, Aitken M, Kingsmore D. A randomized controlled trial of interrupted versus continuous suturing techniques for radiocephalic fistulas. J Vasc Surg. 2015 Dec;62(6):1575-82. doi: 10.1016/j.jvs.2015.07.083. Epub 2015 Oct 23.

Reference Type RESULT
PMID: 26506936 (View on PubMed)

Zeebregts C, van den Dungen J, Buikema H, van der Want J, van Schilfgaarde R. Preservation of endothelial integrity and function in experimental vascular anastomosis with non-penetrating clips. Br J Surg. 2001 Sep;88(9):1201-8. doi: 10.1046/j.0007-1323.2001.01857.x.

Reference Type RESULT
PMID: 11531868 (View on PubMed)

Other Identifiers

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Sutures vs Clips AVF

Identifier Type: -

Identifier Source: org_study_id

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