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Paclitaxel for the Treatment of Distal Radial Artery Arteriovenous Access Fistula Stenosis (PaciFIST-2) (PaciFIST-2)

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ClinicalTrials.gov Identifier: NCT02040454
Recruitment Status : Withdrawn (required catheters not available)
First Posted : January 20, 2014
Last Update Posted : February 2, 2015
Sponsor:
Information provided by (Responsible Party):
Englewood Hospital and Medical Center

Brief Summary:

The objective of this study is to evaluate the safety and effectiveness of the use of intravascular paclitaxel, in addition to standard therapy, for the treatment of arteriovenous dialysis access fistula stenosis.

A fistulogram will be performed in standard fashion. The diagnostic component will include evaluation of the inflow artery, arterial anastomosis and full length of the fistula vein or graft, plus venous return up to the heart. The location, vessel size, lesion diameter and percent stenosis for each lesion will be recorded. Enrollment and randomization will occur at this point.

All patients will then receive standard therapy for their stenosis. This will include intravenous heparin administered in a standard dose of 70 units/kg. Lesions that respond poorly to angioplasty (>30% residual stenosis after angioplasty treatment with 2 inflations) will be stented. Stent selection will be based on clinical setting. Initial stent treatment will utilize an uncovered nitinol stent. Treatment of in-stent restenosis will include initial balloon angioplasty, and use of a covered stent (Viabahn, GORE, or Fluency, Bard). Documentation of location and type of treatment for each lesion treated will be recorded.

Once standard treatment is completed, the operating surgeon will be informed of the results of randomization: treatment (paclitaxel) or control. For subjects assigned to treatment, the whole fistula vein outflow segment of the fistula will be treated with paclitaxel.

The full length of the radial artery from 1 cm of its origin to fistula anatomosis will be treated with paclitaxel. In addition the anastomosis and first 4 cm of the fistula vein will be treated. Paclitaxel solution treatment of each lesion encountered will be attempted until the 20 mg Paclitaxel dose limit is met. The volume administered will depend on the diameter and length of the vessels treated. Maximization of the length of vessel and lesions treated will be undertaken when there are more lesions than can be accommodated by the 12 mg, 10 ml dose available.

A 5 F sheath, 20 cm in length, will be used to administer the paclitaxel. This will be advanced from its distal position in the radial artery over the guidewire so that the tip of the sheath is in the proximal radial artery.

Prior to removal of the sheath, a final angiographic study of all areas treated is performed to document patency and lesion appearance. Any additional lesions identified with this study are then treated appropriately following standard technique.

For the control group, instead of paclitaxel administration, a sham treatment period of 10 minutes is allowed to elapse followed by the performance of the final completion angiogram. Any additional lesions identified with this study are then treated appropriately following standard technique.

All patients will follow the same follow up evaluation schedule


Condition or disease Intervention/treatment Phase
Arteriovenous Access Fistula Stenosis Drug: Paclitaxel Procedure: Standard Therapy Phase 2

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Use of Intravascular Paclitaxel for the Treatment of Distal Radial Artery Arteriovenous Access Fistula Stenosis: A Randomized Study (PaciFIST-2)
Study Start Date : March 2014
Estimated Primary Completion Date : February 2016
Estimated Study Completion Date : October 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Fistulas
Drug Information available for: Paclitaxel

Arm Intervention/treatment
Active Comparator: Standard Therapy Plus Paclitaxel

Standard Therapy - heparin, angioplasty, stent

Paclitaxel - single intravascular dose up to 20 mg

Drug: Paclitaxel
Other Name: Taxol

Procedure: Standard Therapy
Sham Comparator: Standard Therapy Alone
heparin, angioplasty, stent
Procedure: Standard Therapy



Primary Outcome Measures :
  1. Target Lesion Revascularization. [ Time Frame: 6 months ]
    Target lesion revascularization (TLR) is defined as the need for subsequent clinically driven repeat angioplasty, stent placement or other intervention to correct the recurrence of a stenosis at the site treated within 6 months of the initial treatment.

  2. Target Segment Revascularization. [ Time Frame: 6 months ]
    Target segment revascularization (TSR) is defined as the need for secondary clinically driven repeat angioplasty, stent placement or other intervention to correct the recurrence of a stenosis in the radial artery or peri-anastomotic segment of cephalic or basilica vein treated with paclitaxel.


Secondary Outcome Measures :
  1. Safety [ Time Frame: 6 months ]
    The overall serious adverse event (SAE) rate will be determined as well as the rate for each individual type of adverse occurrence or event.

  2. Binary Restenosis [ Time Frame: 6 months ]
    The development of recurrent stenosis of the site treated with angioplasty or angioplasty and stent followed by the paclitaxel controlled infusion. The presence of a binary stenosis is defined as a 50% decrease of the vessel diameter measured on the fistulogram

  3. Primary Patency: Fistula [ Time Frame: 6 months ]
    The interval from treatment until access thrombosis or repeat intervention treatment to maintain fistula function, or the abandonment of the fistula.

  4. Primary Assisted Patency: Fistula [ Time Frame: 6 months ]
    The interval from treatment until access thrombosis, loss or abandonment

  5. Secondary Patency: Fistula [ Time Frame: 6 months ]
    The interval from treatment until access loss or abandonment, or surgical revision that replaces the segment of graft or fistula treated.

  6. Primary Patency: Lesion [ Time Frame: 6 months ]
    The interval from treatment until the lesion treated requires any type of re-treatment or occludes.

  7. Primary Patency: Radial Artery Segment [ Time Frame: 6 months ]
    The interval from treatment until the radial artery inflow segment treated requires any type of re-treatment or occludes.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18 years or older
  • Patient or guardian able to provide a signed informed consent
  • Stenosis of the radial artery or initial 4 cm of the cephalic or basilic vein fistula with the anastomosis in the wrist greater than or equal to 50% treated satisfactorily (less than 20% residual stenosis) with balloon angioplasty alone or balloon angioplasty and stent placement
  • Secondary fistulogram: the patient will have at least one prior fistulogram of the fistula to be treated.
  • Either gender

Exclusion Criteria:

  • Women who are pregnant or who are expected to or might become pregnant
  • Women of child-bearing potential who do not use contraception
  • Life expectancy less than 12 months
  • Known allergy to paclitaxel
  • Known allergy to contrast media not previously demonstrated to be controllable with premedication on a prior study using contrast
  • Known allergy to the pre-medications (dexamethasone, famotidine, diphenhydramine)
  • Pre-fistulogram thrombosis of the fistula
  • Thrombectomy of the fistula within 14 days of the procedure
  • Patient receiving chemotherapy
  • Patients with an immunodeficiency disease or condition
  • Documented hypercoagulable state
  • WBC < 2000/mm3
  • Platelet count less than 100,000/mm3
  • Chronic hepatitis or jaundice
  • Simultaneous enrollment in another investigational device or drug study

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02040454


Locations
United States, New Jersey
Englewood Hospital and Medical Center
Englewood, New Jersey, United States, 07631
Sponsors and Collaborators
Englewood Hospital and Medical Center
Investigators
Principal Investigator: Kurt Wengerter, MD Englewood Hospital and Medical Center

Additional Information:
Responsible Party: Englewood Hospital and Medical Center
ClinicalTrials.gov Identifier: NCT02040454     History of Changes
Other Study ID Numbers: E-13-532
First Posted: January 20, 2014    Key Record Dates
Last Update Posted: February 2, 2015
Last Verified: January 2015

Additional relevant MeSH terms:
Constriction, Pathologic
Fistula
Pathological Conditions, Anatomical
Paclitaxel
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action