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TerminatedNCT04120610Updated Apr 11, 2025Results posted

FlowMet-R Blood Flow Measurement for the Diagnosis of Peripheral Artery Disease and Critical Limb Ischemia

An observational study in Peripheral Artery Disease, sponsored by Medtronic Endovascular. Terminated at 5 sites in United States. Open to participants aged 40 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-04-11.

Sponsored by Medtronic Endovascular · Observational

Why this study was terminated
Sponsor decision to terminate study prior to reaching full sample size.
Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
195
Ages
40 Years and older
Sex
All
01

Study summary

Non-randomized, multi-center, longitudinal study of healthy subjects and subjects with PAD who are scheduled for ABI, TBI, and either Duplex Ultrasound or Angiographic assessments in a vascular clinic.

Read the detailed description

Patients scheduled for peripheral vascular examination and healthy controls will be measured with the FlowMet-R, a noninvasive blood flow monitor, and compared to gold standard diagnostics - ABI, TBI, and Doppler Ultrasound. Sensitivity and specificity of the FlowMet-R device output in diagnosing PAD and CLI will be assessed on initial visit, 3-month followup, and 6-month followup.

02

Conditions studied

  • Peripheral Artery Disease

Keywords

  • Peripheral Artery Disease
  • Claudication
  • Critical Limb Ischemia
03

Who can participate

Ages eligible
40 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes
Sampling method
Probability sample

Study population

The PAD cohort population is persons who have known or suspected peripheral artery disease, and are being seen at a vascular clinic for evaluation.

The Healthy cohort population is adult persons over 40 without history of PAD and who are not currently suspected of suffering from PAD.

Inclusion criteria

PAD Positive Cohort

  • Subject meets PAD positive criteria
  • Subject is willing and able to provide informed consent
  • Subject is willing and able to comply with study procedures
  • Subject is able to understand the study procedures
  • Subject is scheduled for vascular examination that includes noninvasive assessments as standard of care: ABI, TBI, and either a Duplex Ultrasound or Angiogram

Healthy Cohort

  • Subject is willing and able to provide informed consent.
  • Subject is willing and able to comply with the study procedures.
  • Subject is able to understand the study procedures.
  • Subject has no history of positive PAD diagnosis, and is not currently suspected of having PAD.

Exclusion criteria

Exclusion Criteria:

PAD Positive Cohort

  • Subject is under 40 or unable to consent.
  • Subject has any medical condition, which, in the judgment of the Investigator and/or designee, makes the subject a poor candidate for the investigational study.
  • Subject is excluded from analysis if no stenosis is found during Doppler but Tibial disease is suspected and Tibial ultrasound is not able to be performed.
  • Subject does not have a suitable finger to attach the FlowMet-R probe.
  • Subject does not have a suitable 1st or 2nd digit to attach FlowMet-R probe on the limb of interest.
  • Subject has undergone revascularization within the last 90 days
  • Subject cannot lay safely in a supine position.

Healthy Cohort

  • Subject is under 40 or unable to consent.
  • Subject has any medical condition, which, in the judgment of the Investigator and/or designee, makes the subject a poor candidate for the investigational study.
  • One or more limbs has a prior or current diagnosis of PAD, or is reasonably suspected of having a diagnosis of PAD.
  • Subject does not have a suitable finger to attach the FlowMet-R probe.
  • Subject does not have a suitable 1st or 2nd digit to attach FlowMet-R probe.
  • Subject has undergone revascularization within the last 90 days
04

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
195 participants (actual)
Target follow-up
6 Months
Patient registry
Yes

Groups and cohorts

  • Healthy

    Healthy cohort is an age-matched population (over 40 years old) without history of PAD or suspected PAD. Healthy cohort will receive FlowMet-R measurement, Ankle Brachial Index (ABI), and Toe Brachial Index (TBI) measurements.

    Diagnostic Test: FlowMet-R · Diagnostic Test: ABI · Diagnostic Test: TBI

  • Peripheral Artery Disease

    PAD cohort is all-comers to the vascular lab that are scheduled to undergo assessment for Peripheral Artery Disease (PAD) or have a planned endovascular or surgical intervention to address PAD and will receive FlowMet-R measurement in addition to their routine standard of care.

    Diagnostic Test: FlowMet-R · Diagnostic Test: ABI · Diagnostic Test: TBI

Interventions

  • Diagnostic testFlowMet-R

    FlowMet-R is a noninvasive blood flow measurement.

  • Diagnostic testABI

    Ankle Brachial Index is a ratio-metric blood pressure measurement in the ankle and arm.

  • Diagnostic testTBI

    Ankle Brachial Index is a ratio-metric blood pressure measurement in the toe and arm.

05

What researchers measure

Primary outcomes

  1. Sensitivity and Specificity of FlowMet-R for Diagnosis of PAD and CLI

    Primary objective is to determine the efficacy of FlowMet-R measurements in diagnosing PAD \& CLI. All patients were combined from healthy \& PAD groups to form one cohort, ABI and TBI were then used to assign patients in PAD (1), PAD (2) \& CLI. FlowMet-R data (comprised of blood flow measurements and/or feature analysis of the blood flow waveform) were used to create a predictive model of PAD severity. This model was used to generate diagnostic receiver operating characteristic (ROC) curves for PAD and, independently, CLI, at three time points. ROC curves were used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) at the initial, 3-month and 6-month time points. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

    Time frame: Initial, three month, and six month time points.

Secondary outcomes

  1. Sensitivity and Specificity of FlowMet-R for Prognosis of Requiring a Peripheral Vascular Intervention

    ROC curves for predicting if a patient will undergo intervention following their initial visit were generated using FlowMet-R measurement data. ROC curves were used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) within the 3-month and 6-month time points, separately. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

    Time frame: Within three and six months following initial visit

  2. Sensitivity, Specificity and Area Under the Curve (AUC) of FlowMet-R in Diagnosing Significant Stenosis

    ROC curves for predicting a patient has significant stenosis, defined by greater than 50%, in at least one peripheral artery will be generated using FlowMet-R measurement data. ROC curves will be used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) at the initial visit. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

    Time frame: Initial visit

  3. Stenosis Percentage

    A correlation test will be performed between FlowMet-R and stenosis percentage. The correlations between the acceleration time from the FlowMet-R device and peripheral artery stenosis will be computed using a Pearson correlation. Correlation will be computed using available FlowMet-R data from PAD participants with significant stenosis, defined by greater than 50%, in at least one peripheral artery at the initial visit.

    Time frame: Initial visit

  4. Changes in Ankle Brachial Index (ABI)

    The outcome ABI is a ratio of blood pressures in the arm and ankle. Values less than 1 generally indicate narrower arteries. The outcome used the change in ABI for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

    Time frame: Within three and six months following initial visit.

  5. Changes in Toe Brachial Index (TBI)

    The outcome TBI is a ratio of blood pressures in the arm and toe. Values less than 1 generally indicate narrower arteries. The outcome used the change in TBI for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

    Time frame: Within three and six months following initial visit.

  6. Changes in Rutherford Classification

    Rutherford Classification is an ordinal scale that ranges from 0 to 6 and is used to measure peripheral arterial disease severity and chronic limb threatening ischemia. Higher values indicate more severe disease. The changes for Rutherford Classification were computed for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

    Time frame: Within three and six months following initial visit.

06

Results

Posted Apr 11, 2025
Limitations and caveats
The study was terminated by Medtronic prior to completing enrollment. Difficulties with enrollment and limited compliance partially related to the COVID-19 pandemic limited the conclusions. Analyses described in the protocol were computed, but no hypothesis tests were completed. The AUC and its 95% CI are provided to assess the potential for the FlowMet device to classify CLI, PAD (1), PAD (2) at 0-, 3-, and 6-months, reintervention within 3- and 6-months, and significant stenosis.

Participant flow

Participant flow — Overall Study
MilestoneHealthyPeripheral Artery Disease
Started52143
Completed5283
Not completed060

Outcome measures

PrimarySensitivity and Specificity of FlowMet-R for Diagnosis of PAD and CLI

Primary objective is to determine the efficacy of FlowMet-R measurements in diagnosing PAD \& CLI. All patients were combined from healthy \& PAD groups to form one cohort, ABI and TBI were then used to assign patients in PAD (1), PAD (2) \& CLI. FlowMet-R data (comprised of blood flow measurements and/or feature analysis of the blood flow waveform) were used to create a predictive model of PAD severity. This model was used to generate diagnostic receiver operating characteristic (ROC) curves for PAD and, independently, CLI, at three time points. ROC curves were used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) at the initial, 3-month and 6-month time points. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

Time frame:
Initial, three month, and six month time points.
Reported as:
Number · probability
Sensitivity and Specificity of FlowMet-R for Diagnosis of PAD and CLI
probabilityPeripheral Artery Disease (1) vs Not PADPeripheral Artery Disease (2) vs Not PADCritical Limb Ischemia (CLI) vs Not CLI
Sensitivity (Initial)0.80 (0.73 to 0.87)0.78 (0.71 to 0.85)0.82 (0.66 to 0.98)
Specificity (Initial)0.78 (0.70 to 0.87)0.86 (0.78 to 0.94)0.78 (0.72 to 0.84)
Area Under the Curve (Initial)0.84 (0.78 to 0.89)0.87 (0.82 to 0.92)0.86 (0.80 to 0.93)
Sensitivity (3 months)0.52 (0.38 to 0.67)0.57 (0.44 to 0.71)1.00 (1.00 to 1.00)
Specificity (3 months)0.63 (0.46 to 0.81)0.77 (0.60 to 0.95)0.91 (0.84 to 0.97)
Area Under the Curve (3 months)0.58 (0.45 to 0.71)0.67 (0.54 to 0.80)0.95 (0.86 to 1.00)
Sensitivity (6 months)0.74 (0.62 to 0.86)0.73 (0.62 to 0.84)1.00 (1.00 to 1.00)
Specificity (6 months)0.58 (0.41 to 0.74)0.67 (0.48 to 0.86)0.59 (0.48 to 0.69)
Area Under the Curve (6 months)0.62 (0.49 to 0.74)0.67 (0.54 to 0.79)0.79 (0.39 to 1.00)
SecondarySensitivity and Specificity of FlowMet-R for Prognosis of Requiring a Peripheral Vascular Intervention

ROC curves for predicting if a patient will undergo intervention following their initial visit were generated using FlowMet-R measurement data. ROC curves were used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) within the 3-month and 6-month time points, separately. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

Time frame:
Within three and six months following initial visit
Reported as:
Number · probability
Sensitivity and Specificity of FlowMet-R for Prognosis of Requiring a Peripheral Vascular Intervention
probabilityVascular Intervention Within 3 MonthsVascular Intervention Within 6 Months
Sensitivity0.60 (0.30 to 0.90)0.59 (0.35 to 0.82)
Specificity0.49 (0.37 to 0.60)0.56 (0.45 to 0.67)
Area Under the Curve (AUC)0.52 (0.32 to 0.71)0.54 (0.39 to 0.69)
SecondarySensitivity, Specificity and Area Under the Curve (AUC) of FlowMet-R in Diagnosing Significant Stenosis

ROC curves for predicting a patient has significant stenosis, defined by greater than 50%, in at least one peripheral artery will be generated using FlowMet-R measurement data. ROC curves will be used to compute the peak sensitivity, peak specificity, and area under the curve (AUC) at the initial visit. Sensitivity, specificity and AUC are unitless. Sensitivity is the percentage of true positives \& specificity is the percentage of true negatives at the location on the ROC curve where it was closest to the upper left of the unit square from an ROC curve (peak).

Time frame:
Initial visit
Reported as:
Number · probability
Sensitivity, Specificity and Area Under the Curve (AUC) of FlowMet-R in Diagnosing Significant Stenosis
probabilityPAD Participants With Significant Stenosis
Sensitivity0.61 (0.51 to 0.72)
Specificity0.61 (0.48 to 0.75)
Area Under the Curve (AUC)0.63 (0.53 to 0.73)
SecondaryStenosis Percentage

A correlation test will be performed between FlowMet-R and stenosis percentage. The correlations between the acceleration time from the FlowMet-R device and peripheral artery stenosis will be computed using a Pearson correlation. Correlation will be computed using available FlowMet-R data from PAD participants with significant stenosis, defined by greater than 50%, in at least one peripheral artery at the initial visit.

Time frame:
Initial visit
Reported as:
Mean · percentage of stenosis
Stenosis Percentage
percentage of stenosisPAD Participants With Significant Stenosis
Stenosis Percentage67.9 ± 32.5
Statistical analysis
  • PAD Participants With Significant Stenosis · Correlation: 0.26 · 95% CI 0.10 to 0.41
SecondaryChanges in Ankle Brachial Index (ABI)

The outcome ABI is a ratio of blood pressures in the arm and ankle. Values less than 1 generally indicate narrower arteries. The outcome used the change in ABI for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

Time frame:
Within three and six months following initial visit.
Reported as:
Mean · mmHg / mmHg
Changes in Ankle Brachial Index (ABI)
mmHg / mmHg0 to 3 Months0 to 6 Months3 to 6 Months
Changes in Ankle Brachial Index (ABI)0.09 ± 0.230.08 ± 0.310.03 ± 0.22
Statistical analysis
  • 0 to 3 Months · Correlation: -0.26 · 95% CI -0.46 to -0.03
  • 0 to 6 Months · Correlation: -0.33 · 95% CI -0.51 to -0.12
  • 3 to 6 Months · Correlation: -0.13 · 95% CI -0.38 to 0.14
SecondaryChanges in Toe Brachial Index (TBI)

The outcome TBI is a ratio of blood pressures in the arm and toe. Values less than 1 generally indicate narrower arteries. The outcome used the change in TBI for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

Time frame:
Within three and six months following initial visit.
Reported as:
Mean · mmHg / mmHg
Changes in Toe Brachial Index (TBI)
mmHg / mmHg0 to 3 Months0 to 6 Months3 to 6 Months
Changes in Toe Brachial Index (TBI)0.08 ± 0.240.10 ± 0.250.02 ± 0.18
Statistical analysis
  • 0 to 3 Months · Correlation: -0.34 · 95% CI -0.52 to -0.12
  • 0 to 6 Months · Correlation: -0.35 · 95% CI -0.52 to -0.15
  • 3 to 6 Months · Correlation: -0.24 · 95% CI -0.47 to 0.02
SecondaryChanges in Rutherford Classification

Rutherford Classification is an ordinal scale that ranges from 0 to 6 and is used to measure peripheral arterial disease severity and chronic limb threatening ischemia. Higher values indicate more severe disease. The changes for Rutherford Classification were computed for: 0 to 3 months, 0 to 6 months, and 3 to 6 months. The correlation with this outcome was estimated using the corresponding change in acceleration time from the FlowMet-R device.

Time frame:
Within three and six months following initial visit.
Reported as:
Mean · units on a scale
Changes in Rutherford Classification
units on a scale0 to 3 Months0 to 6 Months3 to 6 Months
Changes in Rutherford Classification-0.39 ± 1.4-0.62 ± 1.5-0.26 ± 1.2
Statistical analysis
  • 0 to 3 Months · Correlation: 0.15 · 95% CI -0.08 to 0.36
  • 0 to 6 Months · Correlation: 0.19 · 95% CI -0.02 to 0.39
  • 3 to 6 Months · Correlation: 0.24 · 95% CI -0.02 to 0.47

Adverse events

Collected over Adverse events were collected from the baseline assessment visit throughout 6-month follow-up.. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Healthy0/52 (0%)0/52 (0%)0/52 (0%)
Peripheral Artery Disease4/143 (2.8%)6/143 (4.2%)2/143 (1.4%)
Most frequent serious events
Most frequent serious events
EventHealthyPeripheral Artery Disease
AmputationSurgical and medical procedures0/523/143
Femoral Artery BypassSurgical and medical procedures0/521/143
Femorofemoral BypassSurgical and medical procedures0/521/143
Non-Healing Left Leg UlcerSkin and subcutaneous tissue disorders0/521/143
Cerebrovascular AccidentNervous system disorders0/521/143
Most frequent other events
Most frequent other events
EventHealthyPeripheral Artery Disease
Pain during FlowMet-R AssessmentInjury, poisoning and procedural complications0/521/143
HematomaVascular disorders0/521/143

Baseline characteristics

Site-reported demographic and medical history data are presented based on the assigned cohort using the definitions for Healthy and PAD (2) in the Groups and Interventions Section. Baseline information was not collected for one participant; therefore, a total of 194 participants were included in baseline analysis.

Age, Continuous
Age, Continuous(years)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Mean60.0 ± 13.070.4 ± 9.667.0 ± 11.8
Sex: Female, Male
Sex: Female, Male(Participants)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Female355691
Male2875103
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Hispanic or Latino43236
Not Hispanic or Latino5999158
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
American Indian or Alaska Native000
Asian112
Native Hawaiian or Other Pacific Islander000
Black or African American52126
White5578133
More than one raceNANANA
Unknown or Not Reported23133
Region of Enrollment
Region of Enrollment(participants)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
United States63131194
Weight
Weight(pounds)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Mean183.4 ± 44.8178.4 ± 42.6180.5 ± 43.1
Height
Height(inches)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Mean66.1 ± 4.166.5 ± 4.366.4 ± 4.2
Body Mass Index
Body Mass Index(lbs/(in^2)*703)HealthyPeripheral Artery Disease (Including Critical Limb Ischemia)Total
Mean28.7 ± 7.328.2 ± 5.728.4 ± 6.3

3 further baseline measures are reported on the registry.

07

Study locations

5 sites
  • The Iowa Clinic
    Des Moines, Iowa 50266, United States
  • Mercy Research
    Chesterfield, Missouri 63017, United States
  • The Mt. Sinai Hospital
    New York, New York 10029, United States
  • Ohio Health
    Columbus, Ohio 43214, United States
  • Ascension Seton
    Austin, Texas 78705, United States
08

References and documents

Study documents

  • Study protocol · Jun 25, 2020
  • Statistical analysis plan · Jan 30, 2023

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT04120610
Lead sponsor
Medtronic Endovascular
Collaborators
ICON plc
Responsible party
Sponsor
First posted
Oct 9, 2019
Start date
Dec 9, 2019
Primary completion
Nov 21, 2022
Completion
Nov 21, 2022
Results posted
Apr 11, 2025
Last update
Apr 11, 2025

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
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