Surgical bypass of
peripheral arterial occlusive disease with autologous vein grafts provides an effective means of restoring blood flow to the lower extremity, and has been a standard
therapy for patients with disabling claudication or
critical limb ischemia (CLI). However, failure rates may run as high as 50% within 5 years. These graft failures occur as a result of neointimal
hyperplasia, a ubiquitous
biologic response of blood vessel walls to injury, which is characterized by the migration and proliferation of smooth muscle cells (SMC). The E2F family of
transcription factors regulates the expression of genes controlling SMC proliferation.
Edifoligide (E2F Decoy) is a novel
therapy that inhibits E2F function, thus attenuating neointimal
hyperplasia. Its use in conjunction with a patented
drug delivery pressurization chamber is under investigation. Using this system,
edifoligide is administered to vein grafts in a single, ex vivo treatment following vein harvest and before implantation, resulting in minimal systemic
drug exposure and excellent patient compliance. This Phase 3, randomized, double-blind, multicenter clinical trial is designed to evaluate the safety and efficacy of
edifoligide in a population of approximately 1400 patients with CLI undergoing infrainguinal bypass for
peripheral arterial disease (PAD). The primary outcome measure will be the time to occurrence of non-technical graft failure resulting in either graft revision or major
amputation at 12 months after enrollment. A governing Clinical Events Classification committee (CEC) will adjudicate each graft failure to determine its etiology. The PREVENT III trial is the largest multicenter trial ever performed in patients receiving autologous vein bypass grafts for CLI. This landmark study will determine if
edifoligide is safe and effective at preventing vein graft failure in patients undergoing lower extremity bypass, but it also provides a unique opportunity to observe current treatment practices in
vascular surgery.