In the management of peripheral vascular disease advanced age has often been considered a relative contraindication to attempts at limb salvage procedures. However, failure to intervene may result in a high morbidity and mortality associated with loss of independence and quality of life. We present a review of patients over 70 years of age presenting with ischaemia of the lower limb who were considered for vascular reconstruction. A total of 214 patients had arteriograms between December 1979 and December 1985 in Derby. Following this, 99 (46%) had a vascular reconstruction as the primary procedure, 49 (23%) had an amputation as the primary procedure, and 66 (31%) did not have a major operation. Mortality was high (31% at 6 months), but there was no significant difference between those having amputation and those having vascular reconstruction. However, the outcome of vascular reconstruction in surviving patients was better in terms of independent mobility (63/70 vs. 16/38), long term care (9/70 vs. 22/38), use of hospital beds (27.2 vs. 69.9 days) and was more acceptable to the patient.