A Trial Comparing Routine Versus Selective Use of Completion Angiography After Surgical Thromboembolectomy in the Treatment of Acute Lower Limb Ischemia and Their Impacts on Limb Salvage Rates

NCT ID: NCT03388021

Last Updated: 2018-03-23

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

Clinical Phase

NA

Total Enrollment

92 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-02

Study Completion Date

2018-02-04

Brief Summary

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this randomized controlled trial will compare the impact of routine use of completion angiography versus using it on selective bases after thromboembolectomy in patients with acute lower limb ischemia and their impact on limb salvage rates

Detailed Description

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Conditions

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Acute Limb Ischemia

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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routine use of completion angiography after thromboembolectomy

this group will undergo surgical revascularization followed by routine completion angiography assisted with one of these adjuvant techniques as:

1. Thromboembolectomy under fluoroscopic guidance using Fogarty over the wire
2. Balloon angioplasty and/or stenting
3. Intraarterial thrombolysis

Aiming to correct any residual angiographic lesion as:

1. Residual thrombus
2. Retained embolus
3. Atheromatous plaque

Group Type EXPERIMENTAL

completion angiography followed by endovascular treatment of residual or underlying lesions

Intervention Type PROCEDURE

completion angiography followed by endovascular treatment as thromboembolectomy under fluoroscopic guidance using Fogarty over the wire, angioplasty, stenting, or Intraarterial thrombolysis to treat residual or underlying lesions

if the results were not satisfactory intraoperatively as fail

this group will undergo surgical thromboembolectomy. if the results were not satisfactory intraoperatively as failure to advance the Fogarty catheter or to get satisfactory inflow or backflow or Extraction of intimal fragments.patient will undergo diagnostic angiography and endovascular or surgical intervention according to result of diagnostic angiography.

Group Type ACTIVE_COMPARATOR

completion angiography followed by endovascular treatment of residual or underlying lesions

Intervention Type PROCEDURE

completion angiography followed by endovascular treatment as thromboembolectomy under fluoroscopic guidance using Fogarty over the wire, angioplasty, stenting, or Intraarterial thrombolysis to treat residual or underlying lesions

Interventions

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completion angiography followed by endovascular treatment of residual or underlying lesions

completion angiography followed by endovascular treatment as thromboembolectomy under fluoroscopic guidance using Fogarty over the wire, angioplasty, stenting, or Intraarterial thrombolysis to treat residual or underlying lesions

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Grade I (1) (viable) acute ischemia which there is no immediate threat of limb loss; the patient is presented with neither sensory nor motor weakness and there are audible Doppler signals in both arteries and veins.
* Grade IIA (2 A) (marginally threatened) acute ischemia which needs proper treatment to save the limb; the patient is presented with a minimal sensory loss, no motor weakness, inaudible arterial Doppler signals but the venous Doppler signals are still audible.
* Grade IIB (2 B) (immediately threatened) acute ischemia which needs immediate revascularization to save the limb; the patient is presented with a sensory loss associated with rest pain, mild to moderate motor weakness, inaudible arterial Doppler signals but the venous Doppler signals are still audible.

Exclusion Criteria

* Traumatic or iatrogenic acute limb ischemia
* Grade III acute ischemia (irreversible) with major tissue loss and major amputation is inevitable; the patient presented with sensory and motor loss, inaudible arterial and venous Doppler signals.
* Patients With occluded bypass graft.
* Acute limb ischemia due to intra-arterial injection
* Patients with chronic renal impairment (serum creatinine \> 1.2) or with a history of contrast-induced nephropathy.
* Acute lower limb ischemia due to thrombosed aneurysms
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Amr Elshafie

Assistant Lecturer of vascular surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Mansoura University Hospitals

Al Mansurah, Al Dakhlia, Egypt

Site Status

Countries

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Egypt

References

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Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009 Mar;22(1):5-9. doi: 10.1053/j.semvascsurg.2008.12.003.

Reference Type BACKGROUND
PMID: 19298929 (View on PubMed)

Ouriel K. Endovascular techniques in the treatment of acute limb ischemia: thrombolytic agents, trials, and percutaneous mechanical thrombectomy techniques. Semin Vasc Surg. 2003 Dec;16(4):270-9. doi: 10.1053/j.semvascsurg.2003.08.004.

Reference Type BACKGROUND
PMID: 14691769 (View on PubMed)

Zaraca F, Stringari C, Ebner JA, Ebner H. Routine versus selective use of intraoperative angiography during thromboembolectomy for acute lower limb ischemia: analysis of outcomes. Ann Vasc Surg. 2010 Jul;24(5):621-7. doi: 10.1016/j.avsg.2009.12.006. Epub 2010 Apr 2.

Reference Type RESULT
PMID: 20363108 (View on PubMed)

Zaraca F, Ponzoni A, Sbraga P, Stringari C, Ebner JA, Ebner H. Does routine completion angiogram during embolectomy for acute upper-limb ischemia improve outcomes? Ann Vasc Surg. 2012 Nov;26(8):1064-70. doi: 10.1016/j.avsg.2011.12.012. Epub 2012 Jun 26.

Reference Type RESULT
PMID: 22743219 (View on PubMed)

de Donato G, Setacci F, Sirignano P, Galzerano G, Massaroni R, Setacci C. The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia. J Vasc Surg. 2014 Mar;59(3):729-36. doi: 10.1016/j.jvs.2013.09.016. Epub 2013 Dec 15.

Reference Type RESULT
PMID: 24342067 (View on PubMed)

Argyriou C, Georgakarakos E, Georgiadis GS, Antoniou GA, Schoretsanitis N, Lazarides M. Hybrid revascularization procedures in acute limb ischemia. Ann Vasc Surg. 2014 Aug;28(6):1456-62. doi: 10.1016/j.avsg.2014.01.019. Epub 2014 Feb 11.

Reference Type RESULT
PMID: 24530573 (View on PubMed)

Other Identifiers

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MD/85

Identifier Type: -

Identifier Source: org_study_id

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