Collateral Ligation in Failing Fistulas

NCT ID: NCT03365089

Last Updated: 2018-12-13

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

35 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-14

Study Completion Date

2020-03-31

Brief Summary

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Arteriovenous fistulas (AVFs) for hemodialysis often fail to become usable due to failure to mature (FTM). The most common cause is narrowing of the artery or vein (stenosis). Another potential cause is the presence of collateral or side branch veins that steal blood flow from the main fistula channel. Some believe that occluding these veins might help maturation of those failing AVFs. To evaluate if this actually works, patients with FTM will be randomly assigned to side branch vein ligation (or not), and rates of AVF maturation of the two groups will be compared.

Detailed Description

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Arteriovenous fistulas (AVFs) for hemodialysis often fail to become usable due to failure to mature (FTM). The most common cause is stenosis of the artery or vein. Another potential cause is the presence of collateral or side branch veins that steal blood flow from the main fistula channel. The utility of ligating these veins to improve maturation of those failing AVFs is controversial. To evaluate this, 35 patients presenting for fistulograms for evaluation of AVFs with FTM, found to have side branch veins will be prospectively enrolled. After management of stenoses (if present), they will be randomly assigned to ligation of the venous side branches or not. Maturation rates for each group will be prospectively assessed. For patients assigned to the control group who have persistent failure to mature, a cross-over intervention will be performed and side branch ligation will be offered.

Conditions

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Hemodialysis Access Failure

Keywords

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Hemodialysis fistula Failure to mature Collateral vein

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Collateral vein ligation

Ligation of collateral veins under sonographic guidance

Group Type EXPERIMENTAL

Collateral vein ligation

Intervention Type PROCEDURE

Collateral venous flow will be interrupted by ultrasound-guided ligation of venous side branches.

Control

No collateral vein ligation.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Collateral vein ligation

Collateral venous flow will be interrupted by ultrasound-guided ligation of venous side branches.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

\- Patients with upper extremity autogenous AVF presenting with FTM with evidence of collaterals on ultrasound and/or clinical exam.

Exclusion Criteria

* Age under 18 years
* Pregnant women
* Prior endovascular or surgical procedure in the fistula after its creation (with the exception of surgical superficialization or mobilization)
* Clinical evidence of infection associated with the AVF
* Uncorrectable coagulopathy (International Normalized Radio \>2.5, platelet count \<50.000/μL)
* Absence of significant venous side branches on angiogram (defined as those that arise in the initial 10 cm, including the future cannulation zone, and have maximal diameter greater than or equal to one third of the widest diameter of the fistula's main venous channel in this segment).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Massachusetts General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Zubin Irani

Instructor in Inteventional Radiology, Harvard Medical School

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Zubin Irani, MD

Role: PRINCIPAL_INVESTIGATOR

Massachusetts General Hospital

Locations

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Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Zubin Irani, MD

Role: CONTACT

Phone: 617-643-0765

Email: [email protected]

Facility Contacts

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Zubin Irani

Role: primary

References

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Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT Jr, Murad MH, Montori VM, O'Hare AM, Calligaro KD, Macsata RA, Lumsden AB, Ascher E; Society for Vascular Surgery. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg. 2008 Nov;48(5 Suppl):2S-25S. doi: 10.1016/j.jvs.2008.08.042.

Reference Type BACKGROUND
PMID: 19000589 (View on PubMed)

Lok CE. Fistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol. 2007 Sep;2(5):1043-53. doi: 10.2215/CJN.01080307. Epub 2007 Aug 16. No abstract available.

Reference Type BACKGROUND
PMID: 17702726 (View on PubMed)

Patel ST, Hughes J, Mills JL Sr. Failure of arteriovenous fistula maturation: an unintended consequence of exceeding dialysis outcome quality Initiative guidelines for hemodialysis access. J Vasc Surg. 2003 Sep;38(3):439-45; discussion 445. doi: 10.1016/s0741-5214(03)00732-8.

Reference Type BACKGROUND
PMID: 12947249 (View on PubMed)

Miller PE, Tolwani A, Luscy CP, Deierhoi MH, Bailey R, Redden DT, Allon M. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int. 1999 Jul;56(1):275-80. doi: 10.1046/j.1523-1755.1999.00515.x.

Reference Type BACKGROUND
PMID: 10411703 (View on PubMed)

Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005 Jun;67(6):2462-9. doi: 10.1111/j.1523-1755.2005.00355.x.

Reference Type BACKGROUND
PMID: 15882293 (View on PubMed)

Dixon BS, Novak L, Fangman J. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula. Am J Kidney Dis. 2002 Jan;39(1):92-101. doi: 10.1053/ajkd.2002.29886.

Reference Type BACKGROUND
PMID: 11774107 (View on PubMed)

Miller CD, Robbin ML, Allon M. Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int. 2003 Jan;63(1):346-52. doi: 10.1046/j.1523-1755.2003.00740.x.

Reference Type BACKGROUND
PMID: 12472802 (View on PubMed)

Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002 Oct;62(4):1109-24. doi: 10.1111/j.1523-1755.2002.kid551.x.

Reference Type BACKGROUND
PMID: 12234281 (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)

Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, Swan TL, Wojak JC, Nikolic B, Midia M; Society of Interventional Radiology Standards of Practice Committee. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol. 2016 Oct;27(10):1518-30. doi: 10.1016/j.jvir.2016.07.015. Epub 2016 Sep 9. No abstract available.

Reference Type BACKGROUND
PMID: 27622727 (View on PubMed)

Nassar GM. Endovascular management of the "failing to mature" arteriovenous fistula. Tech Vasc Interv Radiol. 2008 Sep;11(3):175-80. doi: 10.1053/j.tvir.2008.09.004.

Reference Type BACKGROUND
PMID: 19100946 (View on PubMed)

Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis. 1999 May;33(5):910-6. doi: 10.1016/s0272-6386(99)70425-7.

Reference Type BACKGROUND
PMID: 10213648 (View on PubMed)

Han M, Kim JD, Bae JI, Lee JH, Oh CK, Ahn C, Won JH. Endovascular treatment for immature autogenous arteriovenous fistula. Clin Radiol. 2013 Jun;68(6):e309-15. doi: 10.1016/j.crad.2013.01.005. Epub 2013 Mar 5.

Reference Type BACKGROUND
PMID: 23465323 (View on PubMed)

Ahmed O, Patel M, Ginsburg M, Jilani D, Funaki B. Effectiveness of collateral vein embolization for salvage of immature native arteriovenous fistulas. J Vasc Interv Radiol. 2014 Dec;25(12):1890-4. doi: 10.1016/j.jvir.2014.08.015. Epub 2014 Oct 3.

Reference Type BACKGROUND
PMID: 25280664 (View on PubMed)

Cui J, Freed R, Liu F, Irani Z. Interrupting Rivaling Access-flow with Nonsurgical Image-guided ligation: the "IRANI" Procedure. Semin Dial. 2015 Nov-Dec;28(6):E53-7. doi: 10.1111/sdi.12450.

Reference Type BACKGROUND
PMID: 26507374 (View on PubMed)

Turmel-Rodrigues LA. Mechanical enhancement of AVF maturation. J Vasc Access. 2014;15 Suppl 7:S55-9. doi: 10.5301/jva.5000232. Epub 2014 Apr 12.

Reference Type BACKGROUND
PMID: 24817456 (View on PubMed)

Haq NU, Albaqumi M. Accessory vein obliteration criteria for immature fistulae: a modest proposal for an old paradigm. Semin Dial. 2014 Sep-Oct;27(5):E51-4. doi: 10.1111/sdi.12239. Epub 2014 May 6.

Reference Type BACKGROUND
PMID: 24796386 (View on PubMed)

Related Links

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https://www.esrdncc.org/en/fistula-first-catheter-last

Fistula First National Vascular Access Improvements Initiative

Other Identifiers

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2017P001237

Identifier Type: -

Identifier Source: org_study_id