Records of 248 patients undergoing aortoiliac reconstruction for occlusive disease between 1957-1975 were reviewed. Carotid bruits were ausculted in 35 patients (14%). Five of the patients with bruits also were thought to have symptoms of transient ischemia. Stroke occurred after operation in 4 of the 248 patients (1.6%). No patient with a previously noted bruit developed postoperative stroke. Two patients with transient cerebral ischemia and no confirmed bruit before operation did develop postoperative strokes. Cerebral angiography was performed in 18 of the patients with carotid bruits. Two of these patients underwent carotid endarterectomy prior to aortoiliac reconstruction. None of these 18 patients developed strokes following their carotid surgery of aortoiliac reconstruction. A 3rd patient with no bruit but with retinal cholesterol emboli also underwent arteriography and endarterectomy without complication. The asymptomatic carotid bruit alone does not indicate an increased risk of stroke during aortoiliac reconstruction. Prophylactic carotid endarterectomy in the asymptomatic patient prior to aortoiliac reconstruction is not supported.