As the prevalence of obesity in the United States continues to increase, the volume of endovascular and fluoroscopically guided procedures is also increasing. With obese patients, it often seems the only consideration is whether the table weight tolerance can accommodate the patient. This is a naive approach to performing procedures in obese patients, as there are multiple considerations involved in providing state-of-the-art endovascular and interventional care to obese patients. A growing collection of literature is beginning to surface regarding the appropriate modifications in the interventional care of these patients. This article reviews the relevant literature on this important subject.