Zettervall SL, Dansey K, Evenson A, et al. - Since liver disease increases mortality following abdominal surgery, including endovascular aortic aneurysm repair, researchers wanted to see how it impacted mortality and morbidity following endovascular and open peripheral vascular disease management. Patients undergoing infra-inguinal bypass and endovascular intervention were evaluated using the National Surgical Quality Improvement Program (2005–2016). A total of 17,603 patients underwent infra-inguinal bypasses. After infra-inguinal bypass, liver fibrosis was linked to higher 30-day mortality and major complications, with outcomes worsening as Model for End-Stage Liver Disease (MELD) scores increased. After bypass, fibrosis was correlated with higher mortality, major complications, pulmonary, and renal complications, and these associations were consistent through multivariable adjustment. There were 7,830 patients who had endovascular intervention, and fibrosis was associated with higher mortality, pulmonary, and renal complications after endovascular intervention as well, but only renal complications persisted after adjustment. Morbidity and mortality increased following bypass in those with MELD scores > 15, but not following endovascular intervention, as seen in in a subgroup analysis of patients with liver fibrosis. In the management of peripheral arterial disease in patients with liver fibrosis, surgeons may consider an endovascular first approach.