BACKGROUND: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both systemic inflammatory diseases that may share similar pathophysiological pathways. Given their potential overlap, the impact of COPD on perioperative outcomes following infrainguinal endovascular revascularization warrants further examination. Therefore, this study aimed to analyze the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization. METHODS: Chronic obstructive pulmonary disease and non-COPD patients who underwent infrainguinal endovascular revascularization were identified in the ACS-NSQIP database from 2012 to 2022. Exclusion criteria included aged less than 18 years and emergency cases. A 1:1 propensity-score matching was used to match demographics, baseline characteristics, symptomatology, and anesthesia. Thirty-day postoperative outcomes were compared. RESULTS: Of 24 223 patients who underwent infrainguinal endovascular revascularization, 2472 (10.21%) had COPD. All COPD patients were 1:1 propensity-score-matched to the non-COPD patients. Chronic obstructive pulmonary disease patients had higher risks of mortality (3.24% vs 2.18%, p=0.03), major adverse cardiovascular events (MACE) (3.48% vs 2.47%, p=0.04), pulmonary complications (3.24% vs 2.02%, p=0.01), and 30-day readmission (15.41% vs 13.23%, p=0.03). All other 30-day outcomes were comparable between the groups. CONCLUSION: Chronic obstructive pulmonary disease independently increases the risk of 30-day mortality and cardiopulmonary complications after infrainguinal endovascular revascularization. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery. CLINICAL IMPACT: Both PAD and COPD are systemic inflammatory diseases that may share similar pathophysiological pathways. This study analyzed the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization. It was found that COPD independently increases the risk of mortality, cardiopulmonary complications, and 30-day readmissions. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications in infrainguinal endovascular revascularization. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery.