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Pilot Study to Determine Percent Tissue Perfusion and Cellular Viability Using SPY Imaging

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2014 by Georgetown University
Sponsor:
Information provided by (Responsible Party):
Christopher Attinger, M.D., Georgetown University
ClinicalTrials.gov Identifier:
NCT01522495
First received: January 27, 2012
Last updated: October 15, 2014
Last verified: October 2014

January 27, 2012
October 15, 2014
April 2013
October 2017   (final data collection date for primary outcome measure)
  • Determination of percent cellular viability [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
    Determine percent cellular viability (vs. apoptotic/dead) of cells at demarcation line
  • Rate of infection, dehiscence and re-amputation [ Time Frame: 20 weeks ] [ Designated as safety issue: No ]
    Rate of infection, dehiscence and re-amputation in patients undergoing SPY imaging
  • Number of debridements, revisional surgeries and days of stay in hospital [ Time Frame: 20 weeks ] [ Designated as safety issue: No ]
    The endpoint for evaluation will be the number of revisional surgeries and number of days of stay in hospital within 20 weeks of the first procedure.
Same as current
Complete list of historical versions of study NCT01522495 on ClinicalTrials.gov Archive Site
Not Provided
Not Provided
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Pilot Study to Determine Percent Tissue Perfusion and Cellular Viability Using SPY Imaging
Pilot Study for: Eye vs. Spy - A Prospective, Randomized Study Evaluating Patient Outcomes With the Use of SPY Imaging During Amputations or Debridements

Little is known about chronic wound microenvironments, especially in peripheral vascular disease (PVD) and diabetic patients. At the demarcation line, the percentage of viable cells and tissue is unclear. A means to determine cell viability, particularly discerning an apoptotic or necrotic cell pathway would indicate where the line of demarcation should be drawn. The information generated would better predict clinical outcome using SPY Imaging. Cellular studies are needed to successfully confirm a clear line of demarcation to eliminate surgeon subjectivity.

Peripheral arterial disease (PAD), like other more central macrovascular diseases, is common in diabetes. PAD can lead to critical limb ischemia, either alone or when combined with an injury like a foot ulcer. The diabetic foot ulceration requires adequate circulation to heal; if the circulation is impaired such that the tissue oxygen demand exceeds supply, critical limb ischemia ensues, placing the limb at risk.

Most often, patients with critical limb ischemia, undergo multiple debridements in the operating room as well as vascular procedures, prior to reaching a viable level of amputation. This increases the patients' co-morbidities from repetitive exposure to anesthesia. Each debridement may be removing viable tissue and decreasing the length of the eventual amputation. Additionally, intraoperatively, the viability of the skin edges is a subjective assessment based on the surgeon's experience. That judgement can be inaccurate in 10-20% of cases and lad to reoperation. With the use of the SPY imaging system, a better assessment of not only macrovascularity, but also microvascularity of the tissues is able to be evaluated objectively. This helps identify the tissues that are underperfused.

The investigators are unaware of any literature evaluating the use of SPY imaging in the lower extremities intraoperatively during amputations or debridements. There are many studies published for the use of this technology during ophthalmic procedures , cerebral aneurismal repair, cardiac surgery and breast reconstruction. In cardiac surgery, the use of ICG based imaging has proven to be helpful in assessing the quality of bypass grafts and eliminating the need for radiography or catheter insertion (Reuthebuch et al., 2004). In ophthalmic procedures, ICG angiography has been fundamental in identifying many microvascular pathologies (Slakter, Yannuzzi, Guyer, Sorenson, & Orlock, 1995). Furthermore, neurosurgeons have found that the use of ICG angiography is far more superior than DS angiography in identifying small vessels . As it has already been proven to be a good adjunct intraoperatively to visualize microvasculature, the investigators would like to apply this to the lower extremities. Identifying underperfused tissues intraoperatively can help the surgeon objectively decide an appropriate level of amputation/debridement to effectively minimize the number of revisional surgeries. Also, there are no studies that comprehensively evaluate and compare the effectiveness of other modalities that also attempt to assess vascularity with the SPY imaging system. The information gained could be pivotal and help to gain more insight in patients with difficult to heal wounds, especially in the presence of PVD.

Interventional
Not Provided
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Basic Science
Peripheral Vascular Disease
  • Device: SPY Imaging, ICG dye (0.2 - 0.5 mg/kg)
    Intravenous(1X) in conjunction with SPY Imaging (1 arm)
    Other Name: Indocyanine Green, IC-GREEN
  • Device: SPY Imaging
    SPY Imaging to assess tissue perfusion
  • Experimental: SPY Imaging
    SPY Imaging Prior to Amputation or Debridements (50 participants)
    Interventions:
    • Device: SPY Imaging, ICG dye (0.2 - 0.5 mg/kg)
    • Device: SPY Imaging
  • No Intervention: No SPY Imaging
    Amputation or Debridements as Standard of Care (50 participants)
  • Experimental: Validation Against Angiogram

    Patients who are scheduled to undergo an angiogram will also receive ICG angiography (SPY). This will occur at specific time points: 1.) before the angiogram/intervention is performed 2.) immediately after the angiogram/intervention is performed 3.) 5-7 days after angiogram/intervention 4.) 21-30 days after angiogram/intervention.

    (30 participants)

    Interventions:
    • Device: SPY Imaging, ICG dye (0.2 - 0.5 mg/kg)
    • Device: SPY Imaging
  • Experimental: Establishing Normal Values
    To establish baseline lower extremity perfusion in non-PVD patients. Patients requiring an angiogram for other vascular processes unrelated to the lower extremity will be recruited into this study. ICG angiography (SPY) of the lower extremity will be performed at the time of the angiogram. (30 Participants)
    Interventions:
    • Device: SPY Imaging, ICG dye (0.2 - 0.5 mg/kg)
    • Device: SPY Imaging
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
160
October 2017
October 2017   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Subject is at least 18 years or older.
  • Subject has PVD demonstrated by angiogram.
  • Subject is undergoing the first amputation/debridement after vascular intervention, if intervention is/was warranted.
  • Subject has had a vascular consult and/or intervention.
  • Subject must sign an IRB approved informed consent.
  • Subject is willing and able to complete required follow up.

Exclusion Criteria:

  • Subject has no evidence of PVD
  • Subject's wound presents with a malignancy in the wound bed.
  • Subject has liver disease (Previously diagnosed with liver disease or elevated AST, ALT, Alk Phos, or Bilirubin labs within 30 days of procedure).
  • Subject has a disorder or situation that the investigator believes will interfere with study compliance.
Both
18 Years and older
No
Contact: HAley Brown 202-444-0793 Haley.C.Brown@gunet.georgetown.edu
United States
 
NCT01522495
Eye vs. Spy Pilot Study, 2011-114
Yes
Christopher Attinger, M.D., Georgetown University
Georgetown University
Not Provided
Principal Investigator: Christopher E Attinger, MD Georgetown University
Study Director: Paul J Kim, DPM Georgetown University
Georgetown University
October 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP