Introduction. Modern interventional radiology has become the foundation for treating many cardiovascular diseases in elderly patients. At the same time, the global epidemic of obesity and excess body weight (BMI) is leading to an increasing number of patients referred for endovascular interventions having an elevated body mass index (BMI). The interaction of these two factors — advanced age and obesity — creates a unique clinical profile of the patient, requiring a special approach at all stages of care. In this article, we will examine the key features of this profile, based on current data from the scientific literature. Goal. To characterize the clinical and geriatric profile of patients over 65 years of age with excess body weight and obesity who are referred for endovascular interventions, and to identify predictors of unfavorable outcomes based on an analysis of scientific literature data. Materials and methods. This work is a systematic review of the literature with elements of meta analysis of studies devoted to the clinical outcomes of endovascular interventions in elderly patients with excess body weight and obesity. Results and discussion. «The obesity paradox». Meta analyses confirm that in elderly patients with excess body weight, mortality after endovascular interventions is 14–43 % lower than in patients with normal weight; however, this protective effect weakens with age and is neutralized in patients ≥65 years old. Sarcopenic obesity. The combination of obesity with muscle mass loss is the most unfavorable phenotype — the risk of cardiovascular events is more than 6 fold higher. Assessment of muscle strength and body composition should be mandatory during preoperative preparation.Technical aspects. Obesity increases the radiation load and the risk of infectious complications at the access site, but the technical success of the procedures is comparable to that in patients without obesity. Risk stratification should take into account not only BMI but also geriatric syndromes (fragility, sarcopenia). Patients with a combination of these factors require a multidisciplinary approach. Conclusion. The clinical and geriatric profile of a patient with excess body weight and obesity in endovascular practice is a profile full of contradictions. On the one hand, the “obesity paradox” gives them a certain survival advantage compared to patients with normal or reduced weight. On the other hand, they present a more complex technical challenge for the surgeon, involving high radiation doses and an increased risk of infectious complications.