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Stenosis of Arteriovenous Dialysis FistulaFAVABEDNCT02913274

Arteriovenous Fistulae: Drug-eluting Balloon Angioplasty

A study testing Paclitaxel (Taxol) eluting angioplasty balloon, high-pressure angioplasty balloon and low-pressure balloon in people with Stenosis of Arteriovenous Dialysis Fistula, run by Rennes University Hospital at 10 sites in France.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Dysfunctions such as tight stenosis or thrombosis in haemodialysis vascular accesses are the leading cause of hospitalisationand morbidity in chronic haemodialysis patients incurring significant related costs estimated at over one billion dollars in the USA. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Paclitaxel (Taxol) eluting angioplasty balloon, high-pressure angioplasty balloon and low-pressure balloon
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
115 participants
Where
10 sitesFrance
Study dates
20 Mar 2017to 21 Apr 2020
Phase
Interventional
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

Who may be able to join

  • Age ≥ 18,
  • Stage 5 renal failure patients on permanent haemodialysis treatment (every 2 or 3 days),
  • Native and efficient arteriovenous fistula > 3 months,
  • 3mm ≤ reference vein diameter ≤ 8 mm and stenosis length ≤ 10 cm (range of DEB diameters and lengths),
  • Absence of fistula thrombosis,
  • Possibility of crossing the stenosis with a guide wire,
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  • Significant stenosis > 50% (in relation to the reference diameter) on the fistulogram,
  • Clinical diagnosis of imminent fistula dysfunction
  • pressure rise during dialysis
  • and/or puncture difficulties
  • and/or recirculation or poor extrarenal clearance
  • and/or decrease in vascular access flow
  • and/or increase in compression time after dialysis
  • Social security affiliation,
  • Receipt of free, informed, written consent.

Who cannot join

  • Multiple stenoses,
  • Goretex® graft prostheses
  • Systemic or local infection,
  • Known allergy to contrast agent or Paclitaxel.
  • Comorbidity not permitting long-term follow-up,
  • Life expectancy < 1 year,
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  • Anticancer treatment (patients treated with chemotherapy for neoplasia),
  • Pregnant or breastfeeding woman,
  • Patients over 18 years of age who are under legal protection (conservatorship, trusteeship, guardianship), or deprived of freedom.

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

France10 sites
  • CHU Bordeaux

    Bordeaux

  • Centre Hospitalier Universitaire de Caen

    Caen

  • Centre Hospitalier Universitaire de Clermont-Ferrand

    Clermont-Ferrand

  • Centre Hospitalier d'Haguenau

    Haguenau

  • APHM Hôpital la Timone

    Marseille

  • Centre Hospitalier Universitaire de Montpellier

    Montpellier

  • Hôpital Européen Georges Pompidou

    Paris

  • Centre Hospitalier Universitaire de RENNES

    Rennes

  • Centre Hospitalier Universitaire de Toulouse

    Toulouse

  • Clinique St Gatien de Tours

    Tours

Other trials in France

About this study

Official title: Fistules Artério-Veineuses: Angioplastie Par Ballon à Elution de Drogue (FAVABED) - Arteriovenous Fistulae: Drug-eluting Balloon Angioplasty

Dysfunctions such as tight stenosis or thrombosis in haemodialysis vascular accesses are the leading cause of hospitalisationand morbidity in chronic haemodialysis patients incurring significant related costs estimated at over one billion dollars in the USA.

Dysfunctions of these vascular accesses are generally treated by conventional angioplasty as this is the least invasive procedure, the alternative being revision surgery. Angioplasty uses an inflatable balloon of various diameters. Different types of angioplasty balloons may be needed to break fibrous venous stenosis, in particular high-pressure balloons or cutting balloons. These angioplasty procedures which are often painful during dilation have a high technical success rate but a poor 1-year patency rate.

Read more

These invasive repeated procedures impair the quality of life of these patients with end-stage renal disease who are on permanent dialysis or awaiting a kidney transplant and for whom vascular access patency is vital.

Due to their traumatic effect on the vessel wall, these procedures induce cell proliferation processes that retrigger neointimal hyperplasia the very act of preserving the haemodialysis access is the key factor in development of a new stenosis and hence a vicious circle of stenosis-angioplasty.

For the past few years, angioplasty balloons delivering anticancer drugs have been developed. These drugs, generally used in high doses for cancer chemotherapy, are released in small doses on the medical angioplasty devices. During inflation, the local release of the anticancer molecule through the different layers of the vessel wall confers local antiproliferative action without the systemic toxic effects associated with high-dose chemotherapy.

These medical devices have demonstrated their efficacy in terms of increase in primary and secondary patency rates on procedures such as coronary artery angioplasty, femoro-popliteal or sub-popliteal artery angioplasty.

These drug-eluting balloons (DEBs) are also CE marked with the recommendation of being indicated for AVF anticancerangioplasties, but no randomised multi-centre clinical trial has proven their medical effectiveness, and in particular their contribution in terms of patency rate improvement. However, studies on animal models show significant results regarding efficacy against neointimal hyperplasia and the first single-centre clinical trials on a small sample size appear promising.

The key assessment criterion is primary patency of the dilated stenosis at one year defined by patients efficaciously dialysed at one year without re-intervention on the dilated lesion after initial angioplasty. The delay of occurrence of dilation will be considered. Patients that will be non-evaluable for the primary endpointwill be censored at the date of the latest news.

Read the detailed description

Dysfunctions such as tight stenosis or thrombosis in haemodialysis vascular accesses are the leading cause of hospitalisation (20%) and morbidity in chronic haemodialysis patients incurring significant related costs estimated at over one billion dollars in the USA.

Dysfunctions of these vascular accesses are generally treated by conventional angioplasty as this is the least invasive procedure, the alternative being revision surgery. Angioplasty uses an inflatable balloon of various diameters. Different types of angioplasty balloons may be needed to break fibrous venous stenosis, in particular high-pressure balloons (20 atm) or cutting balloons. These angioplasty procedures which are often painful during dilation have a high technical success rate (90-97%) but a poor 1-year patency rate, varying between 26 and 64% depending on the team and a mean rate estimated at 40% for the studies including the larger number of patients, some of whom requiring several procedures.

These invasive repeated procedures impair the quality of life of these patients with end-stage renal disease who are on permanent dialysis or awaiting a kidney transplant and for whom vascular access patency is vital.

Due to their traumatic effect on the vessel wall, these procedures induce cell proliferation processes that retrigger neointimal hyperplasia the very act of preserving the haemodialysis access is the key factor in development of a new stenosis and hence a vicious circle of stenosis-angioplasty.

For the past few years, angioplasty balloons delivering anticancer drugs (Paclitaxel, Sirolimus, Everolimus) have been developed. These drugs, generally used in high doses for cancer chemotherapy, are released in small doses on the medical angioplasty devices. During inflation, the local release of the anticancer (antimitotic) molecule through the different layers of the vessel wall (Paclitaxel is lipophilic and hydrophobic) confers local antiproliferative action without the systemic toxic effects associated with high-dose chemotherapy.

These medical devices have demonstrated their efficacy in terms of increase in primary and secondary patency rates on procedures such as coronary artery angioplasty, femoro-popliteal or sub-popliteal artery angioplasty (treatment of angina or lower limb arteriopathy).

These drug-eluting balloons (DEBs) are also CE marked with the recommendation of being indicated for AVF anticancerangioplasties, but no randomised multi-centre clinical trial has proven their medical effectiveness, and in particular their contribution in terms of patency rate improvement. However, studies on animal models show significant results regarding efficacy against neointimal hyperplasia and the first single-centre clinical trials on a small sample size appear promising.

The key assessment criterion is primary patency of the dilated stenosis at one year defined by patients efficaciously dialysed at one year without re-intervention on the dilated lesion after initial angioplasty. The delay of occurrence of dilation will be considered (censored criteria). Patients that will be non-evaluable for the primary endpoint (death, lost to follow-up…) will be censored at the date of the latest news.

Being tested
Paclitaxel (Taxol) eluting angioplasty balloon, high-pressure angioplasty balloon, low-pressure balloon

What participants receive

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

  • Paclitaxel (Taxol) eluting angioplasty balloonDevice

    Also called BARD, Lutonix® 035 and Lutonix®5F GeoAlign™

    Dilatation by a high-pressure conventional angioplasty balloon untill disappearance of the stenosis obstructive area and achievement of technical success. Then dilatation by a DEB of the same size for 2 minutes.

  • high-pressure angioplasty balloonDevice

    Also called BARD, Conquest®

    Dilatation by a high-pressure conventional angioplasty balloon untill disappearance of the stenosis obstructive area and achievement of technical success. Then dilatation either by a shame balloon or by a DEB balloon of the same size for 2 minutes.

  • low-pressure balloonDevice

    Also called BARD, Ultraverse®

    Dilatation by a high-pressure conventional angioplasty balloon untill disappearance of the stenosis obstructive area and achievement of technical success. Thenn dilatation by a shame balloon i.e conventional low pression balloon of the same size for 2 minutes.

Study groups in NCT02913274
Study groupRoleWhat they receive
"DEB" armExperimentaldilation by a high-pressure conventional angioplasty balloon (sized to fit the reference native vein diameter) until disappearance of the stenotic obstructive area and achievement of technical success (possibility of changing balloon size or dilation pressure) then dilation by a DEB.
Receives: Device: Paclitaxel (Taxol) eluting angioplasty balloon; Device: high-pressure angioplasty balloon
"conventional angioplasty" armActive comparatordilation will be performed by a conventional high-pressure balloon until technical success is achieved (possibility of changing balloon size or dilation pressure), then by a sham balloon i.e a conventional low-pressure balloon (placebo)
Receives: Device: high-pressure angioplasty balloon; Device: low-pressure balloon

What is being measured

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

  1. Number of patients whose haemodialysis is efficient at 1 year without needing further treatment of the stenotic site after initial angioplasty

    assess the primary patency at 1 year after the dilatation of native AVF stenosis with "active" drug-eluting balloons (DEB) compared to conventional "plain" balloons, i.e to compare between the two groups the number of patients whose haemodialysis is efficient at 1 year without needing further treatment of the stenotic site after initial angioplasty.

    Measured: 1 year

Secondary outcomes (6)
  1. primary patency at 6 months

    assess the advantages of Drug-Eluting Balloon compared to conventional plain balloon for primary patency at 6 months of the dilated stenosis

    Measured: 6 months

  2. overall primary patency of the Arteriovenous Fistula at 1 year

    assess the advantages of Drug-Eluting Balloon compared to conventional plain balloon for overall primary patency of the Arteriovenous Fistula at 1 year (patency including AVF dysfunction in relation to the initial dilated stenosis as well as stenoses distant from the initially treated site)

    Measured: 1 year

  3. assisted primary patency of the dilated stenosis at 1 year

    assess the advantages of Drug-Eluting Balloon compared to conventional plain balloon for assisted primary patency of the dilated stenosis at 1 year: Arteriovenous Fistula patency and continuation of efficient haemodialysis sessions with new angioplasties on the initially dilated stenotic site (excluding de-obstruction for complete thrombosis)

    Measured: 1 year

  4. secondary patency of the AVF at 1 year

    assess the advantages of Drug-Eluting Balloon compared to conventional plain balloon for secondary patency of the Arteriovenous Fistula at 1 year: Arteriovenous Fistula patency and continuation of efficient haemodialysis sessions also including complete thrombosis de-obstruction procedures

    Measured: 1 year

  5. The minimal diameter of the treated stenosis and the AVF flows

    assess the advantages of Drug-Eluting Balloon compared to conventional plain balloon for the minimal diameter of the treated stenosis (Late Luminal Loss) and the Arteriovenous Fistula flows (both criterion being evaluated by Doppler ultrasound and Transonic® after angioplasty, and at 6 months and 1 year follow-up).

    Measured: 1 year

  6. Overall and cardiovascular survival

    during analysis in sub-groups, the advantage of these Drug-Eluting Balloons for Overall and cardiovascular survival at 2 and 5 years for all patients and for subgroup of patients with symptomatic peripheral artery disease

    Measured: 5 years

Timeline

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

  1. First posted23 Sep 2016 (estimated)
  2. Study start20 Mar 2017
  3. Primary completion21 Apr 2020
  4. Study completion21 Apr 2020

Why it stopped: The study was temporarily suspended after a meta-analysis suggesting higher mortality risks among patients treated with Paclitaxel-coated balloons. When the study was open again, no new patient accepted to be included. The study stopped on 18AUG2023.

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
115 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02913274
Sponsor's protocol ID
2016-A00420-51
Acronym
FAVABED
Status last verified
Dec 2023
First submitted
20 Sep 2016
Last updated
26 Dec 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing Paclitaxel (Taxol) eluting angioplasty balloon, high-pressure angioplasty balloon and low-pressure balloon in people with Stenosis of Arteriovenous Dialysis Fistula, run by Rennes University Hospital at 10 sites in France.

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 15 inclusion and 9 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: stopped early, as of the sponsor's last update on 26 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in France. 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 was stopped early (reason given: The study was temporarily suspended after a meta-analysis suggesting higher mortality risks among patients treated with Paclitaxel-coated balloons. When the study was open again, no new patient accepted to be included. The study stopped on 18AUG2023.). Results are not available in the source record.

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?

Number of patients whose haemodialysis is efficient at 1 year without needing further treatment of the stenotic site after initial angioplasty (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 26 Dec 2023.

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