In general, aortoiliac and aortoiliofemoral reconstruction when properly selected and properly performed is one of the most gratifying peripheral vascular procedures. The mortality is reasonably low in spite of the fact that the patients operated upon have generalized arteriosclerosis, including coronary artery diseases. The precise procedure selected depends upon many factors having to do with the patient's general condition, body habitus, and artery condition. Although thromboendarterectomy always will have a place, it has been superseded largely by bypass grafts because grafting is an easier operation. As yet, however, bypass grafts have not been shown to have a clear-cut superiority in long-term patency.