Placement of Covered Stents to Treat Hemodialysis Access Stenoses in the Cephalic Arch and Central Veins
| Status: | Recruiting |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology |
| Healthy: | No |
| Age Range: | 18 - 70 |
| Updated: | 4/2/2016 |
| Start Date: | October 2010 |
| Contact: | Abigail Falk, Dr. |
| Email: | abigailfalk123@pol.net |
| Phone: | 914-683-9731 |
Balloon angioplasty is used to open up a narrowing that forms in hemodialysis fistula. Two
areas of particular problems are the terminal portion of the cephalic vein near the shoulder
and the central veins in the chest. Although angioplasty is standard of care the treated
narrowed segments of vein mostly renarrow within 3 months requiring retreatment to keep your
dialysis access functional. Recently there has been introduction of a new technology called
a covered stent graft. Initial studies suggest that placing this device across the area of
narrowing leads to dialysis access staying open longer and needing less angioplasty
treatments.
This study is designed to compare angioplasty (standard of care) versus using a covered
stent graft. The investigators will then look at the dialysis records and future
fistulograms to see if there is decreased flow through the fistula at 3, 6 and 12 months
after the initial procedure.
areas of particular problems are the terminal portion of the cephalic vein near the shoulder
and the central veins in the chest. Although angioplasty is standard of care the treated
narrowed segments of vein mostly renarrow within 3 months requiring retreatment to keep your
dialysis access functional. Recently there has been introduction of a new technology called
a covered stent graft. Initial studies suggest that placing this device across the area of
narrowing leads to dialysis access staying open longer and needing less angioplasty
treatments.
This study is designed to compare angioplasty (standard of care) versus using a covered
stent graft. The investigators will then look at the dialysis records and future
fistulograms to see if there is decreased flow through the fistula at 3, 6 and 12 months
after the initial procedure.
Inclusion Criteria:
1. Hemodialysis patient with a mature forearm or upper arm access that was created > 2
months before enrollment in study.
2. The patient is ≥ 18 years of age.
3. The patient has a reasonable expectation of remaining on hemodialysis for 12 months.
4. The patient or his/her legal guardian understands the study and is willing and able
to comply with follow-up requirements.
5. The patient or his/her legal guardian is willing to provide informed consent.
6. The patient has lesions that meet the angiographic inclusion / exclusion criteria and
induce clinical, hemodynamic or functional abnormality.
Exclusion Criteria:
1. The patient has a known or suspected systemic infection.
2. The patient has a known or suspected infection of the hemodialysis access and / or
bacteremia.
3. The patient is currently taking maintenance immunosuppressant medication such as
rapamycin, mycophenolate or mycophenolic acid, prednisone (>10 mg per day),
cyclosporine, tacrolimus, or cyclophosphamide.
4. The patient has known bleeding disorder (e.g., hemophilia or von Willebrand's
disease).
5. The patient has known sensitivity to heparin.
6. The patient is scheduled for a live donor kidney transplant.
7. The patient is enrolled in another investigational study or another access
maintenance trial
8. The patient has comorbid conditions that may limit their ability to comply with the
follow-up requirements
9. Life expectancy is ≤ 24 months.
10. The patient has an untreatable allergy to radiographic contrast material.
11. The patient is pregnant.
12. In the opinion of the operating physician, the patient's hemodialysis access circuit
is unsuitable for endovascular treatment.
13. The patient's access is planned to be abandoned within 1 year.
14. The patient has indwelling catheters (dialysis, pacemakers, ports).
15. The patient has a central vein stent that would lead to jailing of the internal
jugular vein.
16. The patient experiences angioplasty-induced venous rupture.
17. The patient has a flow limiting dissection after angioplasty.
18. The patient's hemodialysis access is thrombosed.
We found this trial at
3
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