A randomized multicentric study for endovascular treatment of patients with obstructive disease in the SFA (superficial femoral artery) and in the popliteal artery.

This interventional study will collect data about the treatment of de novo lesions or restenotic lesions. Restenotic lesions that are previously DCB (drug coated balloon) treated or in-stent restenosis are excluded in this study.

The primary objective of this randomized study is to compare the efficacy of the DCB (Legflow - Cardionovum) versus POBA for the treatment of de novo lesions or restenosis in the SFA and in the popliteal artery (segment P1 -P2) by assessing the binary restenosis rate with duplex ultrasonography at 12 months.

The secondary endpoints are the assessment of the immediate procedural outcome, distribution of Rutherford, mortality, target lesion revascularization (TLR), target extremity revascularization (TER), amputation and anklebrachial index (ABI).

For each patient enrolled, data will be collected up to 12 months after the procedure.

Inclusion Criteria:

1. Patient must sign the informed consent form prior to the index-procedure.
2. Patient must be older than 18 years.
3. Patient with Rutherford 2, 3 and 4..
4. Target lesion is an occlusion or ≥70% stenosis (visual estimate) located in SFA or popliteal artery (P1 -P2).
5. Maximum length of the target lesion is 13 cm.
6. Target lesion is TASC A, B or C.
7. Target lesion is a de novo lesion or restenotic lesion (previously POBA treated, in-stent restenosis is not allowed).
8. Inflow arteries are free from hemodynamically significant obstruction (i.e. ≥ 50% diameter stenosis). It is allowed to treat inflow lesions during the index-procedure if the result is ≤ 30% diameter stenosis (treatment with DCB or DES is not allowed). Treatment of a non-target lesion in the target vessel is allowed if the nontarget lesion is considered to be an inflow lesion.
9. Popliteal artery P3 segment (below knee popliteal artery) is free from hemodynamically significant obstruction (i.e. ≥ 50%). Treatment of a lesion in this segment is not allowed during the index-procedure.
10. At least 1 patent (< 50% diameter stenosis) below-the-knee vessel (anterior tibial artery, posterior tibial artery or peroneal artery) till the ankle as confirmed by baseline angiography.

Exclusion Criteria:

1. Patient is already included in this study (recruitment of the contralateral leg is not allowed).
2. Patient has a known intolerance to antiplatelet therapy or contrast agent.
3. Patient with known sensitivity to Paclitaxel.
4. Patient is pregnant or patient intends to become pregnant within 1 year after the index-procedure.
5. Patient takes esomeprazole or omeprazole.
6. Patient with serum creatinine >2.0 mg/dL or renal dialysis.
7. Patient suffers from acute limb ischemia defined as any sudden decrease in limb perfusion causing a potential threat to limb viability.
8. Patient has a life expectancy <2 years.
9. Patient with Rutherford 0, 1 , 5 and 6.
10. Patient has a target lesion that is severely calcified (grade 3 and grade 4).
11. Patient with a TASC D lesion.
12. Patient has an acute thrombus or aneurysm in the target vessel.
13. Patient has a target lesion that cannot be crossed with a guidewire.
14. Target vessel has been treated previously with a DCB or a DES.
15. Treatment of outflow lesions during the index-procedure.
16. Patients with significant disease of all 3 infrapopliteal vessels (i.e. ≥ 50% diameter stenosis in each vessel).
17. Any scheduled surgery within 3 months after the index-procedure that would necessitate the discontinuation of clopidogrel.
18. Patients with previous bypass surgery involving the SFA.
19. Patient has cirrhosis of the liver.