Angiography has associated morbidity and mortality, but it is the road map for the vascular surgeon. Can blood vessels be safely operated on without first obtaining an angiogram? It was the purpose of this retrospective analysis to ascertain the need for and value of carotid angiography in patients with amaurosis fugax. Twenty-eight patients (18 men and 10 women) with an average age of 66.4 years (range 58 to 71 years) had histories consistent with amaurosis fugax and were operated on for it. They did not have a history of transient ischemic attacks or stroke. Histories were reviewed for cardiac disease, smoking, hypertension, and diabetes. All patients were studied by noninvasive methods (bidirectional Doppler analysis, oculoplethysmography, carotid phonoangiography, and real-time B-mode ultrasonography), cerebral computerized tomographic scan, and angiography. Nineteen of the 28 patients (11 men and 8 women) had fluorescein angiography. All preoperative computerized tomographic scans were negative. Findings on real-time B-mode ultrasonography suggested significant ulcerated plaque in all of the patients. Angiography could only confirm ulcerated areas in 17 of the 28 patients. Of the patients studied by fluorescein angiography, 17 of 19 (10 men and 7 women) had confirmed embolic lesions. Surgery confirmed ulcerative lesions in all of the 28 patients. Results of this study indicate that if a patient has a history consistent with amaurosis fugax, a negative computerized tomographic scan, and a positive real-time B-mode ultrasonogram, an angiogram may not be necessary.