Clinical trial NCT01602159: Revascularization With Open Bypass Versus Angioplasty and STenting of the Lower Extremity Trial (ROBUST)
Official title: Revascularization With Open Bypass Versus Angioplasty and STenting of the Lower Extremity Trial (ROBUST)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Superficial Femoral Artery Stenosis
Superficial Femoral Artery Occlusion
Claudication
Rest Pain
Keywords: Claudication
SFA
Open Bypass
Angioplasty
Stenting
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
First posted: 2012-05-18
Enrollment: 29
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a prospective randomized controlled trial to compare clinical improvement, cost effectiveness and patency rates between new and improved Nitinol stents and open bypass surgery in the superficial femoral artery disease.

Secondary outcomes also include comparing quality of life, re-intervention rate, mortality, morbidity and time to return to work or regular activities.

Patients with superficial femoral artery lesions will be considered. Patients with TASC II A lesions will not be randomized but treated with PTA/stenting as standard of care. Patients with TASC II B and C lesions will be prospectively randomized into either receiving open bypass or stenting.

Patients with TASC D lesions will be treated with open bypass surgery after angiography.

The investigators will collect pre-procedure, peri-procedural and clinical follow-up data on all enrolled the patients.


Eligibility criteria: Inclusion Criteria:

Clinical Inclusion:

1. Must be at least 18 years of age.
2. Patient has been informed of the nature of the study, and has provided written informed consent, approved by the appropriate Institutional Review Board (IRB)/Medical Ethics Committee (MEC) of the respective clinical site.
3. Symptomatic patient as evidence by IC or CLI.
4. Patient has failed maximized medical treatment and exercise program.
5. Patient has a resting ABI \< 0.9 or an abnormal exercise ABI if resting ABI is normal.Patient with non-compressible arteries (ABI \> 1.2) must have a TBI \< 0.8.
6. Patient has a de novo or restenotic lesion(s) with \> 50% stenosis documented angiographically.
7. Patient agrees to return for all required clinical contacts following study enrollment.
8. Patient has no childbearing potential or has a negative pregnancy test within one week prior to the study procedure.

Anatomical Inclusion:

1. Patient with any SFA lesion
2. At least one tibial vessel runoff with \< 50% stenosis
3. Lesion starts start at least 1 cm distal to the deep femoral artery
4. Lesion end at least 3 cm above the knee joint
5. Target vessel reference diameter is \> 3 mm \& \< 6.5 mm

Exclusion Criteria:

Clinical exclusion:

1. Known allergic reaction to anesthesia not able to overcome by medication.
2. Known allergic reaction to contrast not able to overcome by medication.
3. Known history of intolerance to study medicating including ASA, clopidogrel, or ticlopidine.
4. Bleeding disorder or refuses blood transfusion.
5. Prior stenting or bypass of SFA (prior PTA is not an exclusion criteria)
6. Unstable angina, recent MI within a month
7. Malignancy or other condition limiting life expectancy to \< 5 years.
8. Renal insufficiency (serum Cr \> 2.0)
9. Patient has any condition that precludes proper angiographic assessment or makes percutaneous arterial access unsafe (e.g., morbid obesity).

Anatomic Exclusion:

1. Lesion \< 1 cm from origin of DFA
2. Lesion \< 3 cm from the knee joint
3. Chronic total occlusion of SFA \> 20cm.
4. Chronic total occlusion of CFA.
5. Proximal trifurcation occlusions.

Primary outcomes:
measure: Clinical improvement
timeFrame: 12 Month Post Operatively
measure: Patency rate
timeFrame: 12 Month Post Operatively
measure: Cost effectiveness
timeFrame: 12 Month Post Operatively
Secondary outcomes:
measure: Quality of Life improvement
timeFrame: 12 Month Post Operatively
measure: Re-intervention rate
timeFrame: 12 Month Post Operatively
measure: Technical success of both treatment modalities
timeFrame: 12 Month Post Operatively
measure: 30-day operative mortality
timeFrame: 12 Month Post Operatively
measure: Time to return to work and regular activities
timeFrame: 12 Month Post Operatively
measure: Morbidity associated with both treatment modalities
timeFrame: 12 Month Post Operatively
Other outcomes:
Locations:
city: Baltimore
country: United States
facility: Johns Hopkins Hospital
state: Maryland
city: Baltimore
country: United States
facility: Johns Hopkins Bayview Medical Center
state: Maryland
Study officials:
affiliation: Johns Hopkins University
name: Mahmoud B Malas, M.D., MHS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Malas MB, Qazi U, Glebova N, Arhuidese I, Reifsnyder T, Black J, Perler BA, Freischlag JA. Design of the Revascularization With Open Bypass vs Angioplasty and Stenting of the Lower Extremity Trial (ROBUST): a randomized clinical trial. JAMA Surg. 2014 Dec;149(12):1289-95. doi: 10.1001/jamasurg.2014.369.