Exploratory Study of the Efficacy of Standard of Care Revascularization of the Lower Extremity

NCT ID: NCT04720170

Last Updated: 2021-01-22

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

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-15

Study Completion Date

2021-09-15

Brief Summary

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The purpose of this study is to evaluate the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for diabetic peripheral neuropathy.

Detailed Description

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This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.

Participants who satisfy eligibility criteria may undergo standard of care revascularization of one lower extremity as required, with the addition of revascularization of the lateral plantar artery and anterior pedal loop followed by a 26-week follow-up phase. Standard of Care revascularization will be performed in any limb with ≥ 50% stenosis as determined by intra-vascular ultrasound (IVUS) at the time of planned study intervention.

Participants will be evaluated prior to intervention and at 2, 4, 14 and 26 weeks after the pedal loop intervention.

Conditions

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Diabetic Peripheral Neuropathy

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

26 week, single arm, single site
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Single Arm

This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.

Group Type OTHER

Revascularization

Intervention Type PROCEDURE

Angiogram and IVUS with revascularization of the lateral plantar artery and pedal arch on target foot.

Interventions

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Revascularization

Angiogram and IVUS with revascularization of the lateral plantar artery and pedal arch on target foot.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Male or female age 30 to 80 years (inclusive at first screening visit)
2. Clinical diagnosis of type 1 or type 2 diabetes as diagnosed by HbA1c ≥ 6.5% or current treatment
3. Clinical signs and symptoms of diabetic peripheral neuropathy bilaterally affecting the lower extremities, in the investigator's opinion, which may include neuropathic symptoms (e.g., numbness, tingling, burning sensation, sharp pains, sensitivity to touch) and decreased distal sensation (e.g., decreased vibration, pinprick or pain sensation, monofilament)
4. HbA1c ≤ 11% (historical results allowed if performed within the past 90 days)
5. Females of child-bearing potential who are willing to use contraceptive measures to prevent pregnancy for the duration of the study
6. Willing to attend all scheduled study visits and undergo all study procedures
7. Clinical diagnosis of Peripheral Artery Disease (PAD)
8. Be able to understand, speak, read and write English
9. Have medical insurance or financial means to cover the cost of the revascularization procedure and follow-up visits with the Interventional Radiologist

Exclusion Criteria

1. Inability to undergo angiogram with revascularization
2. Unilateral neuropathic findings or symptoms
3. Vitamin B-12 level \< 400 pg/ml (historical results allowed if performed within the past 30 days) \*
4. Known causes of peripheral neuropathy other than diabetes, e.g., Amyloidosis, Tangier disease, Fabry's disease, hereditary sensory autonomic neuropathy, alcohol-related neuropathy, drug-induced neuropathy (e.g., chemotherapy, antibiotics, anti-retroviral agents, other neurotoxic agents) hypothyroidism that is not well controlled, rheumatoid arthritis or autoimmune disorders requiring treatment with corticosteroids, anti-tumor necrosis factor or immune-modulating medicines
5. Known history of Hepatitis B, C, or HIV
6. Lower limb amputation, including toe
7. Lower extremity inoperable occlusive vascular disease
8. Inability to provide informed consent
9. History of bleeding disorders
10. History of diabetic ulcers to the lower extremities
11. History of any surgical bypass of the lower extremities prior to randomization
12. History of previous revascularization of the lower extremities prior to randomization
13. End Stage Renal Disease (ESRD) requiring or on dialysis
14. Thyroid Stimulating Hormone -TSH \>10.0 uu/mL\*
15. Potassium \> 5.5 mmol/L. \*
16. Calcium \< 8.5 mg/dL or \> 11mg/dL \*
17. Hemoglobin \< 9.0 g/dL \*
18. Female that is pregnant, breastfeeding or intends to become pregnant during the study period
19. Clinically significant abnormal ECG findings, in the opinion of the Investigator
20. Participation in another clinical trial with investigational drug or device at time of screening
21. Any other clinically significant disorders or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study or unable to comply with the protocol requirements
Minimum Eligible Age

30 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Modern Vascular, LLC

UNKNOWN

Sponsor Role collaborator

Diabetes and Glandular Disease Clinic

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dallas Broadway, MD

Role: PRINCIPAL_INVESTIGATOR

Modern Vascular, LLC

Mark S Kipnes, MD

Role: PRINCIPAL_INVESTIGATOR

Diabetes and Glandular Disease Clinic, P.A.

Locations

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Diabetes and Glandular Disease Clinic, P.A.

San Antonio, Texas, United States

Site Status

Countries

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United States

Central Contacts

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Terri L Ryan, RN

Role: CONTACT

210-614-8612 ext. 1630

Josette M Negrete, BAAS

Role: CONTACT

210-614-8612 ext. 1515

References

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Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004 Apr;108(3):248-257. doi: 10.1016/j.pain.2003.12.024.

Reference Type RESULT
PMID: 15030944 (View on PubMed)

Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001 Nov;44(11):1973-88. doi: 10.1007/s001250100001.

Reference Type RESULT
PMID: 11719828 (View on PubMed)

Ibrahim S, Harris ND, Radatz M, Selmi F, Rajbhandari S, Brady L, Jakubowski J, Ward JD. A new minimally invasive technique to show nerve ischaemia in diabetic neuropathy. Diabetologia. 1999 Jun;42(6):737-42. doi: 10.1007/s001250051222.

Reference Type RESULT
PMID: 10382594 (View on PubMed)

Malik RA, Masson EA, Sharma AK, Lye RH, Ah-See AK, Compton AM, Tomlinson DR, Hanley SP, Boulton AJ. Hypoxic neuropathy: relevance to human diabetic neuropathy. Diabetologia. 1990 May;33(5):311-8. doi: 10.1007/BF00403326.

Reference Type RESULT
PMID: 2376302 (View on PubMed)

Newrick PG, Wilson AJ, Jakubowski J, Boulton AJ, Ward JD. Sural nerve oxygen tension in diabetes. Br Med J (Clin Res Ed). 1986 Oct 25;293(6554):1053-4. doi: 10.1136/bmj.293.6554.1053.

Reference Type RESULT
PMID: 3094772 (View on PubMed)

Ram Z, Sadeh M, Walden R, Adar R. Vascular insufficiency quantitatively aggravates diabetic neuropathy. Arch Neurol. 1991 Dec;48(12):1239-42. doi: 10.1001/archneur.1991.00530240043016.

Reference Type RESULT
PMID: 1845025 (View on PubMed)

Singleton JR, Bixby B, Russell JW, Feldman EL, Peltier A, Goldstein J, Howard J, Smith AG. The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy. J Peripher Nerv Syst. 2008 Sep;13(3):218-27. doi: 10.1111/j.1529-8027.2008.00180.x.

Reference Type RESULT
PMID: 18844788 (View on PubMed)

Tesfaye S, Harris N, Jakubowski JJ, Mody C, Wilson RM, Rennie IG, Ward JD. Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography. Diabetologia. 1993 Dec;36(12):1266-74. doi: 10.1007/BF00400804.

Reference Type RESULT
PMID: 8307254 (View on PubMed)

Veves A, Donaghue VM, Sarnow MR, Giurini JM, Campbell DR, LoGerfo FW. The impact of reversal of hypoxia by revascularization on the peripheral nerve function of diabetic patients. Diabetologia. 1996 Mar;39(3):344-8. doi: 10.1007/BF00418351.

Reference Type RESULT
PMID: 8721781 (View on PubMed)

Young MJ, Veves A, Walker MG, Boulton AJ. Correlations between nerve function and tissue oxygenation in diabetic patients: further clues to the aetiology of diabetic neuropathy? Diabetologia. 1992 Dec;35(12):1146-50. doi: 10.1007/BF00401368.

Reference Type RESULT
PMID: 1478366 (View on PubMed)

Young MJ, Veves A, Smith JV, Walker MG, Boulton AJ. Restoring lower limb blood flow improves conduction velocity in diabetic patients. Diabetologia. 1995 Sep;38(9):1051-4. doi: 10.1007/BF00402174.

Reference Type RESULT
PMID: 8591818 (View on PubMed)

Related Links

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Other Identifiers

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DBMK-001

Identifier Type: -

Identifier Source: org_study_id

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