The results of 177 reconstructions for aorto-iliac occlusive disease are presented. All operation, and evaluations of immediate and long term results obtained, were performed by one surgeon. Two basic techniques, endarterectomy and synthetic grafts were used. The results were assessed by the life table method. At ten years there was no statistical difference between the two groups. Endarterectomy, and graft insertion appear to be complementing each other, rather than representing two different modalities of therapy. The importance of thorough evaluation of the cerebral and coronary circulation prior to reconstruction of the aorto-iliac segment is emphasized.