A REVIEW of 400 major vascular reconstructive procedures performed at San Francisco Veterans Administration Hospital in the past six years revealed that most of the serious morbidity and mortality occurs in the emergency cases. There were 25 deaths in 106 emergency operations for aneurysm and occlusive disease and only six deaths in 269 elective operations of the same type (Table 1). The most significant finding was that 18 out of the 31 deaths in both emergency and elective groups were related to cardiopulmonary complications. If the eight immediate deaths from exsanguination (in the ruptured aneurysm group) are excluded, three fourths of the postoperative deaths from arterial reconstruction for disease of the infrarenal aorta or its branches were due to problems with the heart and lungs. Analysis of these cardiopulmonary deaths showed that many had a common group of findings which were not congestive failure, myocardial infarction, or pneumonia, despite the