Kidney Failure, Chronic, Renal Dialysis
Conditions
Keywords
Vascular Access, Hemodialysis Access, End Stage Renal Disease, Kidney Failure, Hemodialysis, Arteriovenous Graft, AVG, Cannulation, Quick Sealing dialysis graft
Brief summary
The CSP-1001 study will evaluate the safety and effectiveness of the InnAVasc arteriovenous graft (AVG) when implanted in and used for hemodialysis in participants suffering from end stage renal failure (ESRD). The InnAVasc AVG is implanted and used similar to other standard of care dialysis grafts currently on the market. However, the InnAVasc AVG has been uniquely designed to potentially allow for immediate needle access (same day as implant surgery as opposed to 2-4 weeks of waiting), to potentially reduce excessive bleeding from the graft after dialysis, and it may provide protection from improper or missed needle cannulation attempts.
Detailed description
The CSP-1001 study will evaluate the safety and effectiveness of the InnAVasc arteriovenous graft (AVG) when implanted in and used for hemodialysis in participants suffering from end stage renal failure (ESRD). The InnAVasc AVG is implanted and used similar to other standard of care dialysis grafts currently on the market. However, the InnAVasc AVG has been uniquely designed to potentially allow for immediate needle access (same day as implant surgery as opposed to 2-4 weeks of waiting), to potentially reduce excessive bleeding from the graft after dialysis, and it may provide protection from improper or missed needle cannulation attempts. This clinical investigation is a prospective, multi-center, single arm, non-randomized study. Participants with ESRD who require hemodialysis and are suitable for an AVG for hemodialysis access will be eligible for inclusion in the study. Suitable participants will be implanted with an InnAVasc AVG in the forearm or upper arm using standard vascular surgical techniques. The graft will be placed in a straight (soft C) configuration in the upper arm, or looped configuration in the forearm (forearm loop) or upper arm (axillary loop). Twenty-six (26) participants will be enrolled to be implanted with the InnAVasc AVG from up to 7 investigational sites in the United States. The primary effectiveness endpoint of secondary graft patency will be assessed at 6 months but the total study duration is 24 months. The primary safety endpoint will include characterization of dialysis graft adverse events over 6 months. It is hypothesized that the InnAVasc AVG will provide a secondary patency rate similar to the current standard of care dialysis access grafts on the market, but will have the potential to reduce needle cannulation-related adverse events and complications.
Interventions
DEVICEInnAVasc arteriovenous graft surgical implant
An InnAVasc AVG will be surgically implanted into the upper arm or forearm of enrolled participants
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
W.L.Gore & Associates
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Patients will be implanted with an InnAVasc AVG in the forearm or upper arm using standard vascular surgical techniques. There are two model versions of the InnAVasc Graft. The looped model and the straight model. The graft will be placed in a straight (soft C) configuration in the upper arm, or looped configuration in the forearm (forearm loop) or upper arm (axillary loop).
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients with ESRD who are not, or who are no longer, candidates for creation of an autologous AV fistula and therefore need placement of an AV graft to start or maintain hemodialysis therapy; * Age 18 to 80 years old, inclusive; * Suitable anatomy for implantation of upper arm straight or looped graft, or forearm looped graft (graft not to cross the bend of the elbow); * For patients NOT on Coumadin / warfarin, international normalized ratio (INR) ≤1.5; * Able and willing to give informed consent; * Anticipated life expectancy of at least 1 year. Additional inclusion criteria on Day 0 (intraoperative): * Both vessels have been exposed and are deemed appropriate for implantation implantation (i.e. based on the surgeon's opinion, artery is of adequate size, has adequate pulse to support AV access flow and is safely clampable (i.e. artery has lack of significant calcification); and the vein is of adequate size, free of localized sclerosis, and is free of immediate outflow obstruction).
Exclusion criteria
* History or evidence of severe cardiac disease (New York Heart Association \[NYHA\] Functional Class III or IV), myocardial infarction within 6 months prior to enrollment, ventricular tachyarrhythmias requiring continuing treatment, or unstable angina; * Diabetes with a hemoglobin A1c (HbA1c) \> 10% * For upper arm straight configuration, antecubital fossa crease to axillary crease distance \< 18 cm. * History or evidence of severe peripheral arterial disease in the extremity selected for implant (i.e. arterial inflow insufficient to support hemodialysis access); * Known or suspected central vein stenosis or obstruction on the side of planned graft implantation; * In the opinion of the investigator, baseline hypotension, or history of frequent hypotensive episodes during dialysis that puts the patient at increased risk of graft thrombosis; * In the opinion of the investigator, uncontrolled hypertension; * Baseline hemoglobin \<8 g/dL; * Baseline platelet count \<100,000 or \>500,000 cells/mm3; * Documented history of stroke within 6 months prior to enrollment; * Treatment with any investigational drug or device within 30 days prior to enrollment; * Female patients who are pregnant, intending to become pregnant, nursing or intending to breastfeed during the study (pregnancy test may only be omitted, if patient is post-menopausal or has a documented history of hysterectomy); * History of cancer with active disease or treatment within the previous year, except for non-invasive basal or squamous cell carcinoma of the skin; * Immunodeficiency, including documented history of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) or patients receiving immunosuppressive therapy for treatment of an acute inflammatory event or autoimmune flare. Chronic immunosuppressive therapy is acceptable; * Documented or suspected hypercoagulable state; * Bleeding diathesis, other than that associated with ESRD; * Documented history of heparin-induced thrombocytopenia (HIT); * Active local or systemic infection as documented from the medical history or bloodwork / blood culture data. If the infection resolves, the subject must be at least one-week post resolution of that infection before implantation; * Scheduled renal transplant within 6 months; * Any other condition which in the judgment of the investigator would preclude adequate evaluation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Secondary Patency of InnAVasc AVG at 6 Months | at 6 months | Secondary patency is defined as the number of patients free from abandonment, including surgical or endovascular interventions designed to reestablish AVG patency at the 6 month timepoint. |
| Incidence of Adverse Events of Special Interest (AESIs) Through 6 Months | through 6 months | Adverse Events of special interest included: Infection of the study device, pseudoaneurysm formation at any point along the access circuit requiring surgical/endovascular intervention, including thrombin injection and compression, bleeding from the study graft requiring surgical or endovascular intervention or ≥2 units blood transfusion, hematoma from the study graft requiring surgical or endovascular intervention, seroma from the study graft requiring surgical or endovascular intervention, thrombosis of the study graft. |
Countries
United States
Participant flow
Pre-assignment details
Intraoperative enrollment criteria: Both vessels have been exposed and are deemed appropriate for implantation (i.e. based on the surgeon's opinion, artery is of adequate size, has adequate pulse to support AV access flow and is safely clampable (i.e. artery has lack of significant calcification); and the vein is of adequate size, free of localized sclerosis, and is free of immediate outflow obstruction).
Participants by arm
| Arm | Count |
|---|---|
| InnAVasc AVG Treatment Patients will be surgically implanted with an InnAVasc AVG in the forearm or upper arm using standard vascular surgical techniques. The graft will be placed in a straight (soft C) configuration in the upper arm, or looped configuration in the forearm (forearm loop) or upper arm (axillary loop).
InnAVasc arteriovenous graft surgical implant: An InnAVasc AVG will be surgically implanted into the upper arm or forearm of enrolled participants | 26 |
| Total | 26 |
Baseline characteristics
| Characteristic | InnAVasc AVG Treatment |
|---|---|
| Age, Continuous | 59.9 Years STANDARD_DEVIATION 12.4 |
| Body Mass Index | 31.4 kg/m^2 STANDARD_DEVIATION 9.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 24 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 19 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 7 Participants |
| Sex: Female, Male Female | 13 Participants |
| Sex: Female, Male Male | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 3 / 26 |
| other Total, other adverse events | 24 / 26 |
| serious Total, serious adverse events | 12 / 26 |
Outcome results
Primary
Incidence of Adverse Events of Special Interest (AESIs) Through 6 Months
Adverse Events of special interest included: Infection of the study device, pseudoaneurysm formation at any point along the access circuit requiring surgical/endovascular intervention, including thrombin injection and compression, bleeding from the study graft requiring surgical or endovascular intervention or ≥2 units blood transfusion, hematoma from the study graft requiring surgical or endovascular intervention, seroma from the study graft requiring surgical or endovascular intervention, thrombosis of the study graft.
Time frame: through 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| InnAVasc AVG Treatment | Incidence of Adverse Events of Special Interest (AESIs) Through 6 Months | 56 Adverse Events |
Primary
Secondary Patency of InnAVasc AVG at 6 Months
Secondary patency is defined as the number of patients free from abandonment, including surgical or endovascular interventions designed to reestablish AVG patency at the 6 month timepoint.
Time frame: at 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| InnAVasc AVG Treatment | Secondary Patency of InnAVasc AVG at 6 Months | 7 Participants |