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Critical Limb IschemiaCRITISCHNCT01877252

Registry of First-line Treatments in Patients With Critical Limb Ischemia

An observational study of Critical Limb Ischemia, run by St. Franziskus Hospital at 1 site in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The principal research question is which treatment modality between open surgical, endovascular and conservative therapy is the most effective in terms of limb salvage, survival and reinterventions in patients with critical limb ischemia Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Critical Limb Ischemia
What is being tested?
Surgical revascularization, Endovascular revascularization and No vascular intervention
Type of treatment
Surgery or procedure
How many people
1,200 participants
Where
1 siteGermany
Study dates
Jan 2013to Sep 2014
How long will I take part?
2 Years
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The target population consists of patients suffering from critical limb ischemia lasting more than 2 weeks

Who may be able to join

  • Rest pain or tissue loss (Fontaine stages III-IV or Rutherford classes 4 to 6) and/or ankle-brachial index < 0.40

Who cannot join

  • Acute limb-threatening ischemia
  • Bone fractures in the relevant areas
  • Non-atherosclerotic disease (e.g. arteriitis)
  • Documented hypercoagulable diseases

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Department of Vascular Surgery, St. Franziskus Hospital

    Münster, 48145

Other trials in Germany

About this study

Official title: National Registry Investigating the Effectiveness of Different First-line Treatment Strategies in Patients With Critical Limb Ischemia

The principal research question is which treatment modality between open surgical, endovascular and conservative therapy is the most effective in terms of limb salvage, survival and reinterventions in patients with critical limb ischemia

Read the detailed description

The target population consists of patients suffering from critical limb ischemia (CLI) lasting more than 2 weeks. CLI is defined as rest pain or tissue loss (Fontaine stages III-IV or Rutherford classes 4 to 6) and/or ankle-brachial index < 0.40. Patient with acute limb-threatening ischemia, bone fractures in the relevant areas, nonatherosclerotic disease (e.g. arteriitis) and documented hypercoagulable diseases will be excluded from this study. There will be no experimental or control groups. The comparison groups will be:

Group 1: Best endovascular treatment (angioplasty +/- stent) Group 2: Best surgical treatment [bypass (vein or prosthetic)] Group 3: Femoral artery patchplasty +/- profundoplasty (+/- endovascular treatment) Group 4: Best conservative treatment

The proposed sample size amounts to 1200 patients.

To be assessed for eligibility (n=1200) To be allocated to trial (n=1000) To be analysed (n=900)

In CRITISCH registry, randomization or blinding is not feasible, because optimized standard care will be performed as established at each participating centre (best medical treatment). Data storage, validation, monitoring, update, backup and analysis will be performed centrally following established procedures. Web-based software will be used to develop a data model representing the data structure. The data validation will include standard data validation techniques such as the manual review of selected variables and the routine check of missing and outlying data points. Regional staff will be instructed and supervised by study nurse, who will perform the study monitoring. Assessment of relevant prognostic factors during the statistical analysis will prevent biased results due to the non-randomized design and the potential structural inequality.

Being tested
Surgical revascularization, Endovascular revascularization, No vascular intervention
Keywords
critical limb ischemia, endovascular treatment, open surgical repair, diabetic foot
Medical subject headings
Chronic Limb-Threatening Ischemia, Diabetic Foot

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Surgical revascularizationProcedure or surgery

    Also called Vein, PTFE, Dacron, Femoral artery patchplasty

  • Endovascular revascularizationProcedure or surgery

    Also called Balloon angioplasty, Stent, Drug-eluting balloon, Drug-eluting stent

  • No vascular interventionOther

    Also called Major amputation, Minor amputation, Sympatholysis, Conservative treatment

Study groups in NCT01877252
Study groupRoleWhat they receive
Endovascular treatmentAngioplasty +/- stent
Receives: Procedure: Endovascular revascularization
Open treatmentBypass (vein or prosthetic)
Receives: Procedure: Surgical revascularization
Patchplasty/Hybrid treatmentFemoral artery patchplasty +/- profundoplasty +/- endovascular treatment
Receives: Procedure: Surgical revascularization; Procedure: Endovascular revascularization
Conservative treatmentno vascular intervention
Receives: Other: No vascular intervention

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Amputation-free survival

    Above-ankle amputation of the index limb or death (any cause), whichever occurred first

    Measured: at 2 years

Secondary outcomes (5)
  1. Perioperative death

    Measured: 30 days

  2. Major adverse limb event (MALE)

    above ankle amputation of the index limb or major intervention (new bypass graft, jump/interposition graft revision, or thrombectomy/thrombolysis)

    Measured: at 1 year, at 2 years

  3. Major adverse cardiovascular event (MACCE)

    myocardial infarction, stroke or death (any cause)

    Measured: at 30 days, at 1 year, at 2 years

  4. Sustained clinical improvement

    upward shift on the Rutherford or Fontaine classification to a level of intermittent claudication in amputation-free surviving patients without the need for repeated target lesion revascularization (TLR) (primary improvement) or after repeated TLR (secondary improvement)

    Measured: at 1 year, at 2 years

  5. Hemodynamic failure

    first occurrence of any of the following events in a time-to-event fashion: (a) major amputation (transtibial or above) and/or (b) reintervention to maintain vascular patency in the index limb and/or (c) failure to increase ankle-brachial-index (ABI) by at least 0.15 postprocedure] and/or (d) decrease in ABI by 0.15

    Measured: at 30 days, at 1 year, at 2 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Jun 2013 (estimated)
  2. Study startJan 2013
  3. Primary completionSep 2014
  4. Study completionSep 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
1,200 participants (actual)
Target duration
2 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT01877252
Sponsor's protocol ID
CRITISCH132105
Acronym
CRITISCH
Status last verified
Nov 2014
First submitted
20 May 2013
Last updated
19 Nov 2014
Results posted
No
Data monitoring committee
Yes

Publications

  • Setacci C, de Donato G, Teraa M, Moll FL, Ricco JB, Becker F, Robert-Ebadi H, Cao P, Eckstein HH, De Rango P, Diehm N, Schmidli J, Dick F, Davies AH, Lepantalo M, Apelqvist J. Chapter IV: Treatment of critical limb ischaemia. Eur J Vasc Endovasc Surg. 2011 Dec;42 Suppl 2:S43-59. doi: 10.1016/S1078-5884(11)60014-2.

    PubMed 22172473
  • Becker F, Robert-Ebadi H, Ricco JB, Setacci C, Cao P, de Donato G, Eckstein HH, De Rango P, Diehm N, Schmidli J, Teraa M, Moll FL, Dick F, Davies AH, Lepantalo M, Apelqvist J. Chapter I: Definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011 Dec;42 Suppl 2:S4-12. doi: 10.1016/S1078-5884(11)60009-9.

    PubMed 22172472
  • Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005 Dec 3;366(9501):1925-34. doi: 10.1016/S0140-6736(05)67704-5.

    PubMed 16325694
  • Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010 May;51(5 Suppl):5S-17S. doi: 10.1016/j.jvs.2010.01.073.

    PubMed 20435258
  • Conte MS, Geraghty PJ, Bradbury AW, Hevelone ND, Lipsitz SR, Moneta GL, Nehler MR, Powell RJ, Sidawy AN. Suggested objective performance goals and clinical trial design for evaluating catheter-based treatment of critical limb ischemia. J Vasc Surg. 2009 Dec;50(6):1462-73.e1-3. doi: 10.1016/j.jvs.2009.09.044. Epub 2009 Nov 7.

    PubMed 19897335
  • Stavroulakis K, Borowski M, Torsello G, Bisdas T; CRITISCH Collaborators. One-Year Results of First-Line Treatment Strategies in Patients With Critical Limb Ischemia (CRITISCH Registry). J Endovasc Ther. 2018 Jun;25(3):320-329. doi: 10.1177/1526602818771383. Epub 2018 Apr 26.

    PubMed 29968501
  • Meyer A, Fiessler C, Stavroulakis K, Torsello G, Bisdas T, Lang W; CRITISCH collaborators. Outcomes of dialysis patients with critical limb ischemia after revascularization compared with patients with normal renal function. J Vasc Surg. 2018 Sep;68(3):822-829.e1. doi: 10.1016/j.jvs.2017.12.048. Epub 2018 Mar 26.

    PubMed 29598891
  • Stavroulakis K, Borowski M, Torsello G, Bisdas T; CRITISCH collaborators. Association between statin therapy and amputation-free survival in patients with critical limb ischemia in the CRITISCH registry. J Vasc Surg. 2017 Nov;66(5):1534-1542. doi: 10.1016/j.jvs.2017.05.115. Epub 2017 Aug 12.

    PubMed 28807382
  • Uhl C, Steinbauer M, Torsello G, Bisdas T; The CRITISCH collaborators. Outcomes After Endovascular Revascularization in Octogenarians and Non-Octogenarians With Critical Limb Ischemia. J Endovasc Ther. 2017 Aug 1;24(4):471-477. doi: 10.1177/1526602817711424. Epub 2017 Jun 5.

    PubMed 28578624
  • Bisdas T, Borowski M, Stavroulakis K, Torsello G; CRITISCH Collaborators. Endovascular Therapy Versus Bypass Surgery as First-Line Treatment Strategies for Critical Limb Ischemia: Results of the Interim Analysis of the CRITISCH Registry. JACC Cardiovasc Interv. 2016 Dec 26;9(24):2557-2565. doi: 10.1016/j.jcin.2016.09.039.

    PubMed 28007205
  • Meyer A, Lang W, Borowski M, Torsello G, Bisdas T; CRITISCH collaborators. In-hospital outcomes in patients with critical limb ischemia and end-stage renal disease after revascularization. J Vasc Surg. 2016 Apr;63(4):966-73. doi: 10.1016/j.jvs.2015.10.009. Epub 2016 Feb 1.

    PubMed 26843355
  • Bisdas T, Borowski M, Torsello G; First-Line Treatments in Patients With Critical Limb Ischemia (CRITISCH) Collaborators. Current practice of first-line treatment strategies in patients with critical limb ischemia. J Vasc Surg. 2015 Oct;62(4):965-973.e3. doi: 10.1016/j.jvs.2015.04.441. Epub 2015 Jul 14.

    PubMed 26187290

Questions about this trial

What is this clinical trial studying?

An observational study of Critical Limb Ischemia, run by St. Franziskus Hospital at 1 site in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Nov 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Amputation-free survival (time frame: at 2 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01877252, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Nov 2014.

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