APAC (antiplatelet, anticoagulant) is a heparin proteoglycan mimetic medication that works as both an antiplatelet and anticoagulant agent. It is designed to prevent blood clots and improve blood flow. In this trial, it is being tested in patients who have peripheral arterial occlusive disease and chronic limb-threatening ischemia, conditions where arteries in the limbs become blocked. The medication is administered both intravenously (through a vein) and intra-arterially (directly into an artery) during endovascular procedures to help restore blood flow to affected limbs.

Peripheral arterial occlusive disease (PAOD) – A circulatory condition where narrowed arteries reduce blood flow to the limbs, most commonly affecting the legs. The condition develops gradually as arteries become hardened and narrowed due to the buildup of fatty deposits on vessel walls. This progressive disease causes reduced blood flow to affected limbs, leading to decreased oxygen delivery to tissues. Symptoms typically begin with leg pain during physical activity, known as intermittent claudication. As the disease advances, patients may experience pain even at rest and develop tissue changes in their feet or legs.

Chronic limb-threatening ischemia (CLTI) – A severe form of peripheral artery disease characterized by severely reduced blood flow to the lower extremities. The condition results in chronic pain in the feet or toes, even while resting. CLTI causes inadequate blood supply to meet the metabolic demands of the affected limb during rest. The reduced circulation often leads to the development of wounds that heal poorly or not at all. This condition represents an advanced stage of vascular disease where tissues receive critically low levels of oxygen and nutrients.