Background: Critical Limb Ischemia (CLI) often causes disabling symptoms of pain and can lead to loss of the affected limb.

Aim of The Study: Tocompare between DCB and ordinary balloon in management of critical limb ischaemia caused by infragenicular arterial diseases.

Patients and methods: A prospective single blinded randomized study conducted on 40 patients with infragenicular arterial disease between October 2017 and October 2018 at the Department of Vascular Surgery in Al-Azhar University and at Alexandria armed forces hospital.

Results: No major adverse events were reported in either groups apart from the minimal occurrence of puncture site haematoma (1 case ). Two of 10 cases in the DCB group had major amputation and 5 of the 10 cases in the normal balloons had major amputation. There were no significant changes in the ABI values in the different follow up indicating the continuation of the hemodynamic success all through the follow up periods. The wound healing rate at 3 months was (65%) in 13 out of the 20 cases. Who were in Rutherford category 5. The other 7 cases (35%) had major amputations; one of them after 7 days and the 3 other at the end of the first month, two between 1 and 3months, and one at 8 months. These 7 had no problems in the distal arch circulation of the foot, but they were diabetics.

Conclusion: The DCB demonstrated impressive patency rates with low repeat revascularization rates in comparison with other conventional balloons.