Vol 28, No 4 (2021)
Original Article
Published online: 2019-10-21

open access

Page views 1234
Article views/downloads 1007
Get Citation

Connect on Social Media

Connect on Social Media

Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries

Rafał Januszek12, Zoltan Ruzsa34, Andras Nyerges4, Victor Óriás3, Paweł Kleczyński1, Joanna Wojtasik-Bakalarz1, Artur Pawlik1, Salech Arif1, Dariusz Dudek15, Stanisław Bartuś15
Pubmed: 31642053
Cardiol J 2021;28(4):509-518.


Background: The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries.
Methods: The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment.
Results: The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables.
Conclusions: Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.

Article available in PDF format

View PDF Download PDF file


  1. Ruzsa Z, Wojtasik-Bakalarz J, Nyerges A, et al. Long-Term follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion. J Invasive Cardiol. 2017; 29(10): 336–339.
  2. Evans C, Peter N, Gibson M, et al. Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty. Ann R Coll Surg Engl. 2010; 92(4): 347–352.
  3. Angerås O, Albertsson P, Karason K, et al. Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J. 2013; 34(5): 345–353.
  4. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002; 39(4): 578–584.
  5. Coutinho T, Goel K, Corrêa de Sá D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of "normal weight central obesity". J Am Coll Cardiol. 2013; 61(5): 553–560.
  6. Shah R, Gayat E, Januzzi JL, et al. GREAT (Global Research on Acute Conditions Team) Network. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. J Am Coll Cardiol. 2014; 63(8): 778–785.
  7. Kumakura H, Kanai H, Aizaki M, et al. The influence of the obesity paradox and chronic kidney disease on long-term survival in a Japanese cohort with peripheral arterial disease. J Vasc Surg. 2010; 52(1): 110–117.
  8. Murata N, Soga Y, Iida O, et al. Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment. Eur J Vasc Endovasc Surg. 2015; 49(3): 297–305.
  9. Iida O, Soga Y, Hirano K, et al. Midterm outcomes and risk stratification after endovascular therapy for patients with critical limb ischaemia due to isolated below-the-knee lesions. Eur J Vasc Endovasc Surg. 2012; 43(3): 313–321.
  10. O'Connor NJ, Morton JR, Birkmeyer JD, et al. Effect of coronary artery diameter in patients undergoing coronary bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation. 1996; 93(4): 652–655.
  11. Momin AU, Melikian N, Shah AM, et al. Leptin is an endothelial-independent vasodilator in humans with coronary artery disease: Evidence for tissue specificity of leptin resistance. Eur Heart J. 2006; 27(19): 2294–2299.
  12. Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438): 937–952.
  13. World Health Organization. Obesity and Overweight. http://new.who.int/news-room/fact-sheets/detail/obesity-and-overweight (Accessed April 29, 2018).
  14. Gelber RP, Gaziano JM, Orav EJ, et al. Measures of obesity and cardiovascular risk among men and women. J Am Coll Cardiol. 2008; 52(8): 605–615.
  15. Januszek R, Siudak Z, Dziewierz A, et al. Chronic obstructive pulmonary disease affects angiographic presentation and outcomes. Authors' reply. Pol Arch Intern Med. 2018; 128(3): 195–196.
  16. Steinberg BA, Cannon CP, Hernandez AF, et al. Medical therapies and invasive treatments for coronary artery disease by body mass: the "obesity paradox" in the Get With The Guidelines database. Am J Cardiol. 2007; 100(9): 1331–1335.
  17. Delhaye C, Wakabayashi K, Maluenda G, et al. Body mass index and bleeding complications after percutaneous coronary intervention: does bivalirudin make a difference? Am Heart J. 2010; 159(6): 1139–1146.
  18. Mak KH, Bhatt DL, Shao M, et al. The influence of body mass index on mortality and bleeding among patients with or at high-risk of atherothrombotic disease. Eur Heart J. 2009; 30(7): 857–865.
  19. Galal W, van Gestel YR, Hoeks SE, et al. The obesity paradox in patients with peripheral arterial disease. Chest. 2008; 134(5): 925–930.
  20. Landbo C, Prescott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 160(6): 1856–1861.
  21. Tang T, Wu L, Yang L, et al. A sarcopenia screening test predicts mortality in hospitalized older adults. Sci Rep. 2018; 8(1): 2923.
  22. Yang M, Hu X, Wang H, et al. Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study. J Cachexia Sarcopenia Muscle. 2017; 8(2): 251–258.
  23. Iepsen UW, Jørgensen KJ, Ringbaek T, et al. A Systematic Review of Resistance Training Versus Endurance Training in COPD. J Cardiopulm Rehabil Prev. 2015; 35(3): 163–172.