The Safety and Efficacy of an Extravascular, Water-Soluble Sealant for Venous Access-Site Closure

• Sponsor: Medstar Health Research Institute (Other)
• Overall Status: Completed
• CT.gov ID: NCT02438475
• Collaborator: Cardinal Health (Industry)
• Enrollment: 208
• Locations: 2
• Arms: 2
• Duration (Months): 26
• Patients Per Site: 104
• Patients Per Site Per Month: 4

Study Details

Study Description

Brief Summary

Evaluate the safety of the MynxGrip™ extravascular sealant for common femoral vein closure following both diagnostic and interventional procedures as assessed by clinical and imaging criteria.

Condition or Disease	Intervention/Treatment	Phase
Cardiac Diagnostic Procedure; Cardiac Interventional Procedure; Femoral Access Site Closure	Device: Mynx Vascular Closure System; Other: Manual Compression	Phase 4

Detailed Description

The objective of this study is to evaluate the safety of the MynxGrip™ extravascular sealant for common femoral vein closure following both diagnostic and interventional procedures as assessed by clinical and imaging criteria for venous thrombosis at the site of closure device deployment.

This is a single-center prospective study of patients who are undergoing either diagnostic or interventional procedures. A total of 208 patients will be enrolled in this study and will be followed through hospital discharge for safety purposes.

The primary safety endpoint will include both deep venous thrombotic and bleeding/vascular injury related complications prior to discharge. Outcomes will be assessed via clinical evaluation and imaging with clinically indicated as follow:

Assessment of venous thrombosis i. Clinical: Physical exam findings consistent with venous thrombotic/thromboembolic related complication:

• Redness or swelling at the venous puncture site

• Increased lower extremity edema

• Calf pain

• New onset or worsening shortness of breath

• New onset of pleuritic chest pain ii. and if clinically indicated, imaging: venous Doppler ultrasound assessment of obstructive or non-obstructive deep vein thrombosis (DVT)

• Bleeding or vascular related complications i. Damage to the vessel requiring surgical repair ii. Access site bleeding requiring the need for transfusion iii. Nerve injury at access site iv. Generalized infection (septicemia with typical signs, symptoms and positive blood cultures shortly after the index procedure, and requiring treatment with intravenous (IV) antibiotics)Pseudo-aneurysms requiring invasive treatment

• Device/procedure failure Device failure is defined as either the inability to deploy the device or device deployment with inadequate hemostasis requiring conversion to immediate manual pressure, or the eventual need for alternative methods to obtain hemostasis.

Efficacy will be assessed by time to hemostasis; Time to hemostasis is defined as the time from advancer tube removal (i.e., device removal) to the time when hemostasis was first observed.

The study will be conducted following either diagnostic or interventional procedures where venous access was required (via the common femoral vein with insertion of 5, 6, or 7F sheath). Femoral vein hemostasis will be achieved with either manual compression or the MynxGrip VCD system. To assess the primary safety outcome of venous patency and lack of occurrence of DVT, clinical assessment will be performed by the study team vascular access assessment group and when clinically indicated a duplex ultrasound will be performed on patients prior to discharge to evaluation the presence of venous thrombosis.

After enrollment, subjects will be randomized 1:1 to:

• Treatment Group A: Subjects will have venous hemostasis achieved using the MynxGrip vascular closure system in the common femoral vein.

• Treatment Group B: Subjects will have venous hemostasis achieved using manual compression over the common femoral vein.

Subjects who meet all inclusion criteria and none of the exclusion criteria, who agree to participate in this clinical study, and who sign an informed consent will be enrolled.

The patient will undergo the clinically indicated procedure(s) as per standard of care. The type of procedure(s) performed will be collected within the CRF. Once all the clinically indicated procedures have been completed the following assessment will be made with respect to the inclusion criteria:

• Target vein had a maximal sheath size inserted larger that 7Fr

• Multiple (>1) attempts at venous access were attempted in the target vein

• Patient has intra-procedural bleeding around the access site prior to sheath removal

• Critically ill patients requiring intravenous vasopressors for blood pressure stabilization

• Ipsilateral femoral artery puncture or sheath insertion

• Glycoprotein IIb/IIIIa use

• Any bleeding or vascular access-site complication evident pre-venous closure If any of the above are met, then the patient will be considered a screen failure. If one femoral vein was attempted with one or more access attempts with or without sheath insertion and then the contralateral femoral vein is used to gain venous access, the target vein for closure would become the vein with one attempt to achieve access that also fits the inclusion/ exclusion criteria above.

Randomization and Enrollment Once the patient meets all the inclusion criteria and none of the exclusion criteria he/she will be considered enrolled in the study.

Randomization will be performed in a block size of 4 within site to maintain the 1:1 randomization throughout the trial within two patients. Randomization will be assigned in consecutive order for the patient enrollment ID starting with 001 through 208. The randomization assignment will be stored within an opaque envelope and assigned/opened in numerical order.

Study Devices/ Procedures

For the randomization assignments both commercial product will be uses. Please follow the commercial IFU for deployment and/or positioning of the Mynx Vascular Closure. For manual compression please follow the local institutions standard of care for the procedure.

Follow-up Patients will be followed up though hospital discharge to assess the primary safety outcome of deep vein thrombotic and/or bleeding/vascular injury related complications related to the target venous closure site.

To assess this primary safety outcome of venous patency and lack of occurrence of DVT, a clinical assessment this includes the following by systematic physician assessment of the target groin.

Once the patient is placed in the recovery room following the completion of the procedure, a member of the Mynx Grip study team will be called to assess the groin, which includes the information below;

Assessment of Venous Thrombosis:

• Comparing mid calf and mid thigh measurement prior to and post procedure.

• Redness or selling at the venous puncture site

• Physical exam findings consistent with venous thrombotic/thromboembolic related complications (i.e. vein engorgement, presence of chord, syenosis)

• Increased lower extremity edema

• New onset or worsening shortness of breath

• New onset of pleuritic chest pain

Bleeding or Vascular Related complications:

• Damage to the vessel requiring surgical repair

• Access site bleeding requiring the need for transfusion

• Nerve injury at the access site

• Generalized infection

• Pseudo-aneurysms requiring invasive treatment In the event that the Mynx Grip study team believes that further assessment for venous thrombosis of the target femoral vein is necessary, a duplex ultrasound of the target femoral vein will be ordered.

Presence of a venous thrombosis of the target vein will be assessed based on a combination of clinical symptoms and/or result of the duplex ultrasounds. Duplex ultrasounds will be submitted to and assessed by the Duplex Ultrasound Core Lab for a systematic and objective review of the presence of venous thrombosis

Study Design

• Study Type: Interventional
• Actual Enrollment: 208 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Study Start Date: Jun 1, 2015
• Actual Primary Completion Date: Aug 1, 2017
• Actual Study Completion Date: Aug 1, 2017

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Mynx Vascular Closure System Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone	Device: Mynx Vascular Closure System; MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.; Other Names: MynxGrip Vascular Closure Device
Other: Manual Compression Where patients will have venous hemostasis attempted to be achieved using manual compression alone	Other: Manual Compression; manual pressure applied to your groin for approximately 5-10 minutes

Outcome Measures

Primary Outcome Measures

1. Assessment of Venous Thrombosis [Subjects will be followed up until their discharge from the hospital, and expected average of 24 hours]

   i. Clinical: Physical exam findings consistent with venous thrombotic/thromboembolic related complication: Redness or swelling at the venous puncture site Increased lower extremity edema Calf pain New onset or worsening shortness of breath New onset of pleuritic chest pain ii. and if clinically indicated, imaging: venous Doppler ultrasound assessment of obstructive or non-obstructive deep vein thrombosis (DVT)

2. Bleeding or Vascular Related Complications [Subjects will be followed up until their discharge from the hospital, and expected average of 24 hours]

   i. Damage to the vessel requiring surgical repair ii. Access site bleeding requiring the need for transfusion iii. Nerve injury at access site iv. Generalized infection (septicemia with typical signs, symptoms and positive blood cultures shortly after the index procedure, and requiring treatment with intravenous (IV) antibiotics)Pseudo-aneurysms requiring invasive treatment

3. Device/Procedure Failure [intraoperative]

   Device failure is defined as either the inability to deploy the device or device deployment with inadequate hemostasis requiring conversion to immediate manual pressure, or the eventual need for alternative methods to obtain hemostasis.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• Patients > 18 years of age scheduled for a percutaneous diagnostic or interventional procedure that have either a 5, 6, or 7F sheath placed in the common femoral vein.

Exclusion Criteria:

1. Patient has a history of a bleeding disorder

2. Previous history of venous thrombosis or thromboembolism

3. Patient is pregnant or lactating

4. Patient has a known severe allergy to contrast medium

5. Patient has a known allergy to PEG

6. Patient is known to require an extended hospitalization or re-hospitalization (e.g. patient is undergoing coronary artery bypass graft (CABG) surgery) or patient is scheduled to have a CABG surgery <30 days following the procedure) 9. Multiple (>1) attempts at venous access were attempted in the target vein 10. Patient has intra-procedural bleeding around the access site prior to sheath removal 11. Critically ill patients requiring intravenous vasopressors for blood pressure stabilization 12. Ipsilateral femoral artery puncture or sheath insertion 13. Glycoprotein IIb/IIIIa use 14. Any bleeding or vascular access-site complication evident pre-venous closure

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	MedStar Washington Hospital Center	Washington	District of Columbia	United States	20010
2	MedStar Southern Maryland Hospital	Clinton	Maryland	United States	20735

Sponsors and Collaborators

• Medstar Health Research Institute
• Cardinal Health

Investigators

None specified.

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Jul 1, 2014

More Information

Publications

None provided.

• Responsible Party: Medstar Health Research Institute
• ClinicalTrials.gov Identifier: NCT02438475
• Other Study ID Numbers: Vascular Closure Venous Mynx
• First Posted: May 8, 2015
• Last Update Posted: Nov 18, 2020
• Last Verified: Oct 1, 2020

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: Yes

Study Results

Participant Flow

Arm/Group Title	Mynx Vascular Closure System	Manual Compression
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.	Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes
Period Title: Overall Study
STARTED	104	104
COMPLETED	102	104
NOT COMPLETED	2	0

Baseline Characteristics

Arm/Group Title	Mynx Vascular Closure System	Manual Compression	Total
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.	Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes	Total of all reporting groups
Overall Participants	104	104	208
Age (Count of Participants)
<=18 years	0 0%	0 0%	0 0%
Between 18 and 65 years	22 21.2%	26 25%	48 23.1%
>=65 years	82 78.8%	78 75%	160 76.9%
Sex: Female, Male (Count of Participants)
Female	43 41.3%	48 46.2%	91 43.8%
Male	61 58.7%	56 53.8%	117 56.3%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	0 0%	0 0%
Asian	0 0%	0 0%	0 0%
Native Hawaiian or Other Pacific Islander	0 0%	0 0%	0 0%
Black or African American	20 19.2%	32 30.8%	52 25%
White	83 79.8%	69 66.3%	152 73.1%
More than one race	0 0%	0 0%	0 0%
Unknown or Not Reported	1 1%	3 2.9%	4 1.9%
Region of Enrollment (participants) [Number]
United States	104 100%	104 100%	208 100%

Outcome Measures

1. Primary Outcome

Title	Assessment of Venous Thrombosis
Description	i. Clinical: Physical exam findings consistent with venous thrombotic/thromboembolic related complication: Redness or swelling at the venous puncture site Increased lower extremity edema Calf pain New onset or worsening shortness of breath New onset of pleuritic chest pain ii. and if clinically indicated, imaging: venous Doppler ultrasound assessment of obstructive or non-obstructive deep vein thrombosis (DVT)
Time Frame	Subjects will be followed up until their discharge from the hospital, and expected average of 24 hours

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Mynx Vascular Closure System	Manual Compression
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.	Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes
Measure Participants	103	104
Count of Participants [Participants]	0 0%	0 0%

2. Primary Outcome

Title	Bleeding or Vascular Related Complications
Description	i. Damage to the vessel requiring surgical repair ii. Access site bleeding requiring the need for transfusion iii. Nerve injury at access site iv. Generalized infection (septicemia with typical signs, symptoms and positive blood cultures shortly after the index procedure, and requiring treatment with intravenous (IV) antibiotics)Pseudo-aneurysms requiring invasive treatment
Time Frame	Subjects will be followed up until their discharge from the hospital, and expected average of 24 hours

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Mynx Vascular Closure System	Manual Compression
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.	Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes
Measure Participants	103	104
Count of Participants [Participants]	0 0%	0 0%

3. Primary Outcome

Title	Device/Procedure Failure
Description	Device failure is defined as either the inability to deploy the device or device deployment with inadequate hemostasis requiring conversion to immediate manual pressure, or the eventual need for alternative methods to obtain hemostasis.
Time Frame	intraoperative

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Mynx Vascular Closure System	Manual Compression
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.	Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes
Measure Participants	103	104
Count of Participants [Participants]	0 0%	0 0%

Adverse Events

Time Frame	procedure through hospital discharge
Arm/Group Title	Mynx Vascular Closure System		Manual Compression
Arm/Group Description	Where subjects will have venous hemostasis attempted to be achieved using the Mynx Vascular Closure system alone Mynx Vascular Closure System: MynxGrip is being used to seal femoral vein access sites while reducing times to hemostasis and ambulation in patients who have undergone diagnostic or interventional endovascular procedures utilizing a 5F, 6F or 7F procedural sheath.		Where patients will have venous hemostasis attempted to be achieved using manual compression alone Manual Compression: manual pressure applied to your groin for approximately 5-10 minutes
All Cause Mortality
	Mynx Vascular Closure System		Manual Compression
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/104 (0%)		0/104 (0%)
Serious Adverse Events
	Mynx Vascular Closure System		Manual Compression
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/104 (0%)		0/104 (0%)
Other (Not Including Serious) Adverse Events
	Mynx Vascular Closure System		Manual Compression
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	7/104 (6.7%)		15/104 (14.4%)
Blood and lymphatic system disorders
Access site thigh change >2 cm	7/104 (6.7%)	7	15/104 (14.4%)	15

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.