Obesity negatively predicts success rate and outcomes in patients with critical limb ischemia treated by percutaneous angioplasty

Bogdan Dutu*, Horatiu Comsa*, Gabriel Cismaru*, Dana Pop*, Dumitru Zdrenghea*, Adrian Iancu**

*5th Department of Internal Medicine, Cardiology-Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca - **5th Department of Internal Medicine, Heart Institute, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca

Introduction: The obesity paradox postulates that patients with peripheral arterial disease have a better outcome if they are obese. However, studies in patients with coronary or carotid angioplasty have shown that obesity does not influence the success rate of angioplasty or in-hospital procedural outcomes.  

Our study aimed to evaluate the prognostic predictive factors associated with the success rate and  outcome of  percutaneous angioplasty in patients with critical limb ischemia undergoing revascularizationWe evaluated in principal the presence of obesity but also other risk factor such as: gender, age, hypertension, cholesterol, smoking, diabetes, anemia and kidney failure. 

Materials and methods: This is a  retrospective cohort study which included 85 consecutive patients with critical limb ischemia (Fontaine stage III or IV) and angiographic evidence of sub-occlusive or occlusive peripheral artery disease who underwent angioplasty at the Rehabilitation Hospital Cluj-Napoca, Romania, between January 2016 and July 2019.

Results: Of the 180 patients hospitalized with critical limb ischemia,  85 received endovascular therapy. Mean age was 68.2+/-9.8 years, 64.7 % were males. The prevalence of risk factors in our group was: diabetes  57.6 %, smoking 61.2 %, hypertension 82.4%, obesity 17.6  %, anemia 11.8%, kidney failure 11.8% and atrial fibrillation 15.3%. We analyzed the association between different risk factors and the success rate of angioplasty. Only the presence of obesity was negatively associated with the success rate of angioplasty. (p=0.037).

Conclusion: Angioplasty showed enthusiastic clinical outcomes in terms of technical success and limb salvage and proved its efficiency as first option of treatment in patients with CLI. Our data show that obesity is associated with rather unfavorable outcome in patients treated percutaneously.