Percutaneous Less Invasive AV Fistula for Vascular Access in ESRD

Medtronic

Status: Completed

Conditions: AV Fistula; Fistula; End Stage Renal Disease; End Stage Kidney Disease

Treatments: Device: Ellipsys Vascular Access Catheter

Study type: Interventional

Funder types: Industry

Identifiers

NCT02363972

01-0014-01

Details and patient eligibility

About

A prospective single-arm well-controlled study to evaluate the safety and effectiveness of a less invasive means of establishing vascular access to facilitate dialysis in patients with end stage renal disease.

Enrollment: 103 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients were eligible for enrollment into the study if they met the following criteria:

1. Patients ≥ 18 years of age and ≤ 80 years of age

2. Male or non-pregnant female (verified with a urine/blood pregnancy test, for women of reproductive potential)

3. Life expectancy of at least one year, per the investigator's opinion

4. Diagnosed with end-stage renal disease (ESRD) or chronic kidney disease requiring dialysis or anticipated start of dialysis within 6 months of enrollment

5. Patients deemed medically eligible for upper extremity autogenous AV fistula creation, per institutional guidelines and/or clinical judgment

6. Adequate quality vein based on pre-operative assessment

   1. Adjacent vein diameter of ≥ 2.0 mm at target anastomosis site
   2. Confirmed clinically significant outflow

7. Adequate quality radial artery based on pre-operative assessment

   a. Arterial lumen diameter of ≥ 2.0 mm at target anastomosis site

8. Adequate collateral arterial perfusion

   1. Patent palmar arch
   2. Negative Allen's Test for ulnar artery insufficiency

9. No clinical evidence of subclavian artery stenosis on the ipsilateral side.

10. Radial artery-adjacent vein proximity ≤ 1.5 mm measured lumen edge-to-lumen edge as determined by pre-procedural ultrasound and confirmed pre-procedure

11. Patient was able to provide written informed consent

12. Able to travel to enrolling institution for follow-up examinations

13. Able and willing to follow a daily aspirin and/or other anti-coagulation/antiplatelet regimen, not including warfarin (Coumadin, or comparable anti-coagulant, see exclusion criteria 15)

Exclusion criteria

Patients were excluded if any of the following was true:

1. Documented or suspected central venous stenosis including upper extremity arterial stenosis (≥ 50%)
2. a. Prior vascular surgery at or proximal (central) to the AVF target site b. Prior axillary dissection or mastectomy on the ipsilateral side as intended AV fistula site
3. History of steal syndrome from a previous hemodialysis vascular access on the ipsilateral side which required intervention or abandonment
4. Evidence of vascular disease at the radial artery/adjacent vein site on the ipsilateral side
5. Pre-existing vascular disease that could confound the study results
6. Systolic pressures < 100 mm Hg at the time of screening
7. Suspected or confirmed skin disease at the skin entry site
8. Immunocompromised patients (e.g. HIV positive)
9. Edema of the upper extremity on the ipsilateral side
10. Patients requiring immunosuppressant therapy such as sirolimus (Rapamune®) or Prednisone at a dose of > 10 mg per day
11. Peripheral white blood cell count < 1.5 K/mm3 or platelet count < 75,000 cells/mm3
12. Current diagnosis of carcinoma (defined as in remission < 1 year)
13. Pregnant or currently breast feeding
14. Known bleeding diathesis or coagulation disorder
15. Receiving warfarin (Coumadin, or comparable anti-coagulant) therapy
16. Patients with acute or active infection
17. Scheduled kidney transplant within 6 months of enrollment
18. Participation in another clinical investigation (excluding retrospective studies or studies not requiring a consent form)
19. History of substance abuse or anticipated to be non-compliant with medical care or study requirements based on investigator judgment
20. Patient required creation of an arteriovenous fistula distal to the wrist
21. Patient required nerve block requiring immobilization of the arm

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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103 participants in 1 patient group

Ellipsys Vascular Access Catheter

Experimental group

Description:

ESRD patients who require and qualify for creation of a surgical AV fistula will be offered the opportunity to participate in this study for a less invasive way of creating an AV fistula.

Treatment:

Device: Ellipsys Vascular Access Catheter