In a prospective analysis of 150 consecutive major vascular reconstructions, 104 patients were of normal weight (NW), 33 were overweight (OW) and 13 were obese (OB), as defined by body mass index calculations (BMI = kg/m2). Wound infections were more common in OW than NW patients (10/33 versus 10/104, p < 0.01) and in the OB compared to the NW group (4/13 versus 10/104, p < 0.05). Wound dehiscence was more common in the combined OW and OB groups than the NW patients (3/46 versus 0/104, p < 0.01). Chest infections were more common in OB (4/13) than NW (9/104) patients (p < 0.02). Median (interquartile range) in-patient stay was longer in OB patients [34 (15-41) days] compared to OW [14 (10-19) days, p < 0.001] and NW [11 (8-15) days; p < 0.001] patients. Nonetheless, there were no significant differences in the rates of more major complications or operative mortality between the three groups and early infrainguinal graft patency and limb salvage rates were not different. Only one prosthetic graft infection occurred in this series. In conclusion, despite the higher risk of infective complications, major vascular reconstruction can be performed safely in overweight and obese patients.