Drug-Coated Balloon Angioplasty of Infrapopliteal Lesions in Patients with Critical Limb Ischaemia: 1-Year Results of the APOLLO Trial

  • Ulf TeichgräberEmail author
  • Thomas Lehmann
  • Marcus Thieme
  • Kersten-Uwe Wahl
  • Christian Stelzner
  • Albrecht Bormann
  • Linda Götz
  • Tobias Kroeßner
  • Harald Boden
  • Lars Maiwald
  • René Aschenbach
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions



This study intended to assess effectiveness and safety of the drug-coated balloon (DCB) angioplasty of infrapopliteal atherosclerotic lesions in patients with critical limb ischaemia (CLI) in a real-world setting.


Consecutive patients with critical limb ischaemia who underwent infrapopliteal drug-coated balloon angioplasty with the ELUTAX SV DCB were enrolled into the prospective, multicentre, single-arm observational registry. Primary outcome was clinical improvement at 6 and 12 months. Secondary outcomes were change in quality of life, primary patency, freedom from repeat revascularisation, and amputation-free survival at 6 and 12 months.


A total of 164 patients (74.7 ± 9.2 years) with CLI were included at nine German sites between November 2015 and September 2017. The majority (79.9%) of patients had diabetes mellitus, 57.3% had renal insufficiency, and 35.3% had coronary artery disease. Mean lesion length was 71.2 ± 76.5 mm. The Rutherford category improved by 3.0 ± 2.0 (p < 0.0001) within 12 months, resulting in a clinical improvement by at least one Rutherford category in 80.2% of the patients. Walking impairment questionnaire score, European Quality of Life index, and patient-reported pain improved significantly from baseline to 6 and 12 months. Primary patency was 68.5%, freedom from target lesion revascularisation 90.6%, and amputation-free survival 83.5% at 12 months.


Infrapopliteal drug-coated balloon angioplasty with the ELUTAX SV DCB in patients with critical limb ischaemia was efficacious and safe over the medium term. The study is registered with (Identifier: NCT02539940).


Below the knee Critical limb ischaemia Drug-coated balloon angioplasty Drug-eluting balloon Infrapopliteal Paclitaxel Peripheral artery disease 



This study was funded by Aachen Resonance.

Compliance with Ethical Standards

Conflict of interest

All other authors declare that they have no conflict of interest, except of Prof. Teichgräber who received a funding for the APOLLO study by Aachen Resonance.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Ulf Teichgräber
    • 1
    Email author
  • Thomas Lehmann
    • 2
  • Marcus Thieme
    • 3
  • Kersten-Uwe Wahl
    • 4
  • Christian Stelzner
    • 5
  • Albrecht Bormann
    • 6
  • Linda Götz
    • 7
  • Tobias Kroeßner
    • 8
  • Harald Boden
    • 9
  • Lars Maiwald
    • 10
  • René Aschenbach
    • 1
  1. 1.Department of RadiologyJena University HospitalJenaGermany
  2. 2.Center for Clinical StudiesJena University HospitalJenaGermany
  3. 3.REGIOMED Klinikum SonnebergSonnebergGermany
  4. 4.Oberlausitz KlinikenBautzenGermany
  5. 5.Städtisches Krankenhaus Dresden-FriedrichstadtDresdenGermany
  6. 6.Klinikum Altenburger LandAltenburgGermany
  7. 7.Saale-Unstrut Klinikum NaumburgNaumburgGermany
  8. 8.SRH-Waldklinikum GeraGeraGermany
  9. 9.Ilm-Kreis-Kliniken Arnstadt-IlmenauIlmenauGermany
  10. 10.Kreiskrankenhaus TorgauTorgauGermany

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