Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status

Plain English Summary

Background and study aims
Severe limb ischaemia (SLI) is a growing problem in the UK, with one in every 1000-2000 people being diagnosed every year. SLI is a serious condition in which the arteries supplying limbs (most often the legs) with blood become narrowed or blocked due to the build-up of fatty substances (plaque). This often occurs around the knee in the femoral and popliteal arteries (femoropopliteal disease), which means that the lower parts of the limb (such as the feet) do not receive adequate blood supply (vascularisation). In SLI, small injuries to the feet are unable to heal, as they are not being supplied with enough oxygen rich blood. If left untreated, this can lead to ulcers, gangrene and ultimately death of the limb (necrosis). Once the limb “dies” the only available course of action is amputation, which can cause the sufferer a great deal of emotional distress. In recent years, more and more patients are undergoing surgery to improve blood supply to the leg (revascularisation) before amputation becomes the only option. An angioplasty is a common procedure in which a thin tube (catheter) is placed in the narrowed blood vessel. A small balloon on the tip of the catheter is gradually inflated to reopen the artery and flatten the blockage against the artery wall. In some cases, the surgeon may also insert a mesh-like tube (stent) into the artery to keep it open. These techniques are known as endovascular, as they take place inside the artery. In recent years, new techniques have been developed with incorporate drugs designed to stop the blockages coming back. These techniques can be very expensive however, and more research is needed to find out whether they are more effective in the long-term than traditional procedures. The aim of this study is to compare the effectiveness and cost-effectiveness of new endovascular techniques using drugs with traditional methods.

Who can participate?
Adults with severe limb ischaemia due to femoropopliteal disease, who are suitable for early revascularisation.

What does the study involve?
Participants are randomly allocated to one of three groups. Those in the first group are given a plain balloon angioplasty (traditional method), in which a bare metal stent (stent without a coating) is also inserted if required. For those in the second group, the balloon used in the angioplasty procedure is coated in a drug (drug-coated balloon angioplasty) designed to prevent cells from multiplying (cell proliferation) and re-blocking the artery. During the angioplasty procedure, the medication on the balloon surface is deposited on the artery wall when the balloon inflates. Those in the third group have a drug-eluting stent (DES) placed in the artery, which is a stent that is coated in a drug that blocks cell proliferation. After their procedures, patients in all three groups are monitored to find out whether having the endovascular procedure has prevented the need for amputation.

What are the possible benefits and risks of participating?
Not provided at time of registration

Where is the study run from?
Sixty hospitals in England, Scotland and Wales (UK)

When is the study starting and how long is it expected to run for?
November 2015 to June 2021

Who is funding the study?
National Institute for Health Research (UK)

Who is the main contact?
Mr Hugh Jarrett

Trial website

Contact information



Primary contact

Mr Hugh Jarrett


Contact details

The University of Birmingham
B15 2TT
United Kingdom
+44 (0)121 415 8444

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Multi-centre randomised controlled trial of clinical and cost-effectiveness of drug coated balloons, drug eluting stents and plain balloon angioplasty with bail-out bare metal stent revascularisation strategies for severe limb ischaemia due to atherosclerotic femoro-popliteal, with or without infra-popliteal involvement, peripheral arterial disease



Study hypothesis

The aim of this study is to determine whether a drug coated balloon +/- bare metal stent or a drug eluting stent with plain balloon angioplasty or a bare metal stent are the most effective revascularisation strategy and the most clinically and cost-effective treatment strategy for severe limb ischaemia due to femoro-popliteal disease.

Ethics approval


Study design

Randomised; Interventional; Design type: Treatment

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet


Severe limb ischaemia due to femoro-popliteal disease


Participants are randomly allocated to one of three treatment groups.

Group 1: Participants receive a plain balloon angioplasty with a bare metal stent (if needed)
Group 2: Participants receive a drug coated balloon with a bare metal stent (if needed)
Group 3: Participants receive a drug eluting stent

To fully capture this activity, as well as the associated changes in QoL and health resource usage, patients will be closely followed up, for a minimum of two years. Patients are asked to attend follow-up appointments at 1, 6, 12, 24 and 36 months. At each timepoint patients will be asked to complete questionnaires and some of their clinical data will be collected. After 3 years patients will be followed up for primary outcome only (i.e. if they are still alive and still have the trial limb).

Intervention type



Drug names

Primary outcome measure

Amputation free survival (AFS) defined as the time to major limb (above the ankle) amputation of the index (trial) limb or death from any cause

Secondary outcome measures

Not provided at time of registration

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Aged 18 years or over
2. Have severe limb ischaemia due to femoro-popliteal, with or without infra-popliteal, peripheral artery disease
3. Be judged by the responsible clinicians (consultant vascular surgeon, interventional radiologist, diabetologist) working as part of a multidisciplinary team to require early endovascular femoro-popliteal, with or without infra-popliteal revascularisation in addition to best medical treatment, foot and wound care
4. Have adequate ‘inflow’ to support all possible trial revascularisation strategies
5. Be judged suitable for all possible trial revascularisation strategies following diagnostic imaging and a formal (documented) discussion by a multi-disciplinary team meeting

Participant type


Age group




Target number of participants

Planned Sample Size: 861; UK Sample Size: 861

Participant exclusion criteria

1. Have an anticipated life expectancy <6 months
2. Are unable to provide consent due to incapacity (as defined by Mental Capacity Act 2005 or Adults with Incapacity [Scotland] Act 2000)
3. Are a non-English speaker where translation facilities are insufficient to guarantee informed consent
4. Are judged unsuitable for any of the revascularisation strategies being evaluated

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Clinical Trials Unit
The University of Birmingham Edgbaston
B15 2TT
United Kingdom

Sponsor information


University of Birmingham

Sponsor details

Department of Cardiovascular Medicine
Medical School
B15 2TT
United Kingdom

Sponsor type




Funder type


Funder name

National Institute for Health Research

Alternative name(s)


Funding Body Type

government organisation

Funding Body Subtype

Federal/National Government


United Kingdom

Results and Publications

Publication and dissemination plan

Papers will be published following the analysis of the data. A report to the HTA is required within 12 months of trial completion and will also be published.

Intention to publish date


Participant level data

Available on request

Basic results (scientific)

Publication list

2017 protocol in:

Publication citations

Additional files

Editorial Notes

02/04/2019: The condition has been changed from "Topic: Cardiovascular disease; Subtopic: Cardiovascular (all Subtopics); Disease: Atherothrombosis" to "Severe limb ischaemia due to femoro-popliteal disease" following a request from the NIHR. 08/03/2019: The following changes were made to the trial record: 1. The recruitment end date was changed from 15/02/2019 to 01/09/2019. 2. The overall trial end date was changed from 15/02/2019 to 01/06/2021. 22/05/2017: Publication reference added.