Clinical trial NCT01297322: RESPECT Trial - (Rapid Extravascular Sealing Via PercutanEous Collagen ImplanT)
Official title: A Multi-Center, Prospective, Randomized, Controlled, Trial to Evaluate the Safety and Efficacy of the Cardiva VASCADE VCS vs. Manual Compression for the Management of the Femoral Arteriotomy After Percutaneous Endovascular Procedures
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Surgical Wound
Keywords: vascular closure system
manual compression
femoral arteriotomy
percutaneous endovascular procedures
Lead sponsor: Cardiva Medical, Inc.
Sponsor class: INDUSTRY
First posted: 2011-02-16
Enrollment: 420
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The objective of this trial is to demonstrate the safety and effectiveness of the Cardiva VASCADE™ Vascular Closure System (VCS) in sealing femoral arterial access sites. Hypothesis: The Cardiva VASCADE™ VCS provides times to hemostasis (TTH) and time to ambulation (TTA) results that are less than manual compression by a clinically meaningful and statistically significant margin. The rate of major access site-related complications with the Cardiva VASCADE™ VCS is non-inferior to the major complication rates of manual compression for sealing femoral arterial access sites.

Detailed description: A prospective, randomized, controlled multi-center clinical trial designed to evaluate the safety and effectiveness of the study device in sealing femoral arterial access sites and providing reduced times to hemostasis and ambulation compared with manual compression at the completion of diagnostic or interventional endovascular procedures performed through 6 Fr or 7 Fr introducer sheaths. Subjects will be randomized in a 2:1 treatment device to control ratio.

Eligibility criteria: Pre-Operative Inclusion Criteria:

* Patients undergoing an elective, non-emergent diagnostic or interventional endovascular procedure via the common femoral artery using a 6 or 7 Fr introducer sheath

Pre-Operative Exclusion Criteria:

1. Advanced refusal of blood transfusion, if necessary;
2. Active systemic or a cutaneous infection or inflammation;
3. Pre-existing immunodeficiency disorder and/or chronic use of systemic steroids;
4. Known, significant history of bleeding diathesis, coagulopathy, von Willebrand's disease or current platelet count \< 100,000 cells/mm3, baseline INR ≥1.8, or fibrinogen level less than 150 mg/dl (if received a fibrinolytic agent within prior 24 hours);
5. Severe co-existing morbidities having a life expectancy of less than 30 days;
6. Currently involved in any other investigational clinical trial;
7. Ipsilateral femoral arteriotomy within the previous 30 days;
8. Planned endovascular procedure within the next 30 days;
9. Previous ipsilateral femoral artery closure using a permanent implant-based closure device;
10. Previous vascular grafts or surgery at the target vessel access site;
11. History of symptomatic peripheral arterial disease, revascularization or deep vein thrombosis in the ipsilateral limb;
12. Unilateral or bilateral lower extremity amputation(s);
13. Significant anemia with a hemoglobin level less than 10 g/dL or a hematocrit less than 30%;
14. Renal insufficiency (serum creatinine of \> 2.5 mg/dl);
15. Females who are pregnant, planning to become pregnant within 3 months of the procedure, or lactating;
16. Extreme morbid obesity (BMI greater than 45 kg/m2) or underweight (BMI less than 20 kg/m2);
17. Unable to routinely walk at least 20 feet without assistance (see protocol);
18. Known allergy/adverse reaction to bovine derivatives, sodium hyaluronate or hyaluronan preparations;
19. Procedures that extend hospitalization (e.g., staged endovascular procedure, CABG);
20. Administration of low molecular weight heparin (LMWH) within 8 hours of the procedure.

Intra-op Exclusion Criteria

1. An introducer sheath with an overall length greater than 11 cm, or not 6 Fr or 7 Fr diameter;
2. Femoral artery diameter less than 6 mm at access site;
3. Difficult insertion of procedural sheath or needle stick problems at the onset of the procedure (e.g., multiple stick attempts, "back wall stick", etc.);
4. Angiographic evidence of more than minimal calcium, atherosclerotic disease, or stent within 1 cm of the puncture site;
5. Overlapping Common Femoral Vein and Femoral Artery at access site;
6. Placement of ipsilateral venous sheath during procedure;
7. Arterial access site located not at common femoral artery (e.g., on or below the bifurcation, above the lower border of the inferior epigastric artery, or above the pelvic brim);
8. More than one access site required;
9. Loss of distal pulses in the ipsilateral extremity during the procedure;
10. Subjects receiving unfractionated heparin with an ACT greater than 300 seconds in the absence of a glycoprotein IIb/IIIa inhibitor or greater than 250 seconds in the presence of a glycoprotein IIb/IIIa inhibitor (may wait to remove introducer sheath until ACT level reaches the target value);
11. Intra-procedural bleeding around sheath, or suspected intraluminal thrombus, hematoma, pseudoaneurysm, or AV fistula;
12. Systemic hypertension (BP greater than 180/110 mmHg) or hypotension (BP less than 90/60 mmHg) prior to randomization;
13. Length of the tissue tract, the distance between the anterior arterial wall and skin, is estimated to be less than 2.5 cm;
14. If the physician deems that a different method should be used to achieve hemostasis of the arterial site or that the subject should not attempt ambulation according to the protocol requirements.

Primary outcomes:
measure: Time to Hemostasis (TTH)
timeFrame: Up to 1 hour
measure: Rate of Combined Access Site-related Major Complications
timeFrame: 30 days +/- 7 days
Secondary outcomes:
measure: Time to Ambulation (TTA)
timeFrame: Up to 1 day
measure: Time to Discharge Eligibility (TTDE)
timeFrame: Up to 2 days
measure: Time to Hospital Discharge (TTHD)
timeFrame: Up to 2 days
measure: Device Success
timeFrame: Up to 1 day
measure: Procedure Success
timeFrame: 30 days +/- 7 days
measure: Rate of Combined Minor Access Site Complications
timeFrame: 30 days +/- 7 days
Other outcomes:
Locations:
city: Fairhope
country: United States
facility: Thomas Hospital
state: Alabama
city: Newark
country: United States
facility: Christiana Care
state: Delaware
city: Melbourne
country: United States
facility: Holmes Regional Medical Center
state: Florida
city: Springfield
country: United States
facility: St. John's Prairie Heart
state: Illinois
city: Indianapolis
country: United States
facility: St. Vincent's Heart Center of Indiana
state: Indiana
city: Ashland
country: United States
facility: King's Daughters Medical Center
state: Kentucky
city: Houma
country: United States
facility: Terrebonne General Medical Center
state: Louisiana
city: Lafayette
country: United States
facility: Lafayette General Medical Center
state: Louisiana
city: Takoma Park
country: United States
facility: Washington Adventist Hospital
state: Maryland
city: Boston
country: United States
facility: Tufts University
state: Massachusetts
city: Royal Oak
country: United States
facility: William Beaumont Hospital
state: Michigan
city: Camden
country: United States
facility: Cooper Health System
state: New Jersey
city: Mineola
country: United States
facility: Winthrop University Hospital
state: New York
city: New York
country: United States
facility: New York-Presbyterian Hospital
state: New York
city: Winston-Salem
country: United States
facility: Forsyth Medical Center
state: North Carolina
city: Tulsa
country: United States
facility: Oklahoma Heart Institute
state: Oklahoma
city: Austin
country: United States
facility: Heart Hospital of Austin
state: Texas
city: Norfolk
country: United States
facility: Sentara Norfolk General Hospital
state: Virginia
city: Richmond
country: United States
facility: Virginia Commonwealth University Medical Center
state: Virginia
city: Charleston
country: United States
facility: CAMC Health Education and Research Institute, Inc.
state: West Virginia
city: Melbourne
country: Australia
facility: St. Vincent's Hospital Melbourne
state: Victoria
Study officials:
affiliation: The St. Vincent Heart Center of Indiana, St. Vincent Hospital
name: James B. Hermiller, Jr., MD, FACC
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lehmann KG, Heath-Lange SJ, Ferris ST. Randomized comparison of hemostasis techniques after invasive cardiovascular procedures. Am Heart J. 1999 Dec;138(6 Pt 1):1118-25. doi: 10.1016/s0002-8703(99)70078-5.
citation: Simon A, Bumgarner B, Clark K, Israel S. Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization. Am J Crit Care. 1998 Jul;7(4):308-13.
citation: Kussmaul WG 3rd, Buchbinder M, Whitlow PL, Aker UT, Heuser RR, King SB, Kent KM, Leon MB, Kolansky DM, Sandza JG Jr. Rapid arterial hemostasis and decreased access site complications after cardiac catheterization and angioplasty: results of a randomized trial of a novel hemostatic device. J Am Coll Cardiol. 1995 Jun;25(7):1685-92. doi: 10.1016/0735-1097(95)00101-9.
citation: Castaneda F, Swischuk JL, Smouse HB, Brady T. Gelatin sponge closure device versus manual compression after peripheral arterial catheterization procedures. J Vasc Interv Radiol. 2003 Dec;14(12):1517-23. doi: 10.1097/01.rvi.0000099530.29957.dd.
citation: Hoffer EK, Bloch RD. Percutaneous arterial closure devices. J Vasc Interv Radiol. 2003 Jul;14(7):865-85. doi: 10.1097/01.rvi.0000071086.76348.8e.
citation: Gerckens U, Cattelaens N, Lampe EG, Grube E. Management of arterial puncture site after catheterization procedures: evaluating a suture-mediated closure device. Am J Cardiol. 1999 Jun 15;83(12):1658-63. doi: 10.1016/s0002-9149(99)00174-5.
citation: Kinnaird TD, Stabile E, Mintz GS, Lee CW, Canos DA, Gevorkian N, Pinnow EE, Kent KM, Pichard AD, Satler LF, Weissman NJ, Lindsay J, Fuchs S. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol. 2003 Oct 15;92(8):930-5. doi: 10.1016/s0002-9149(03)00972-x.
citation: Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med. 1998 Apr 30;17(8):873-90. doi: 10.1002/(sici)1097-0258(19980430)17:83.0.co;2-i.