Extraperitoneal endarterectomy for iliofemoral occlusive disease. Sixty patients with iliofemoral occlusive disease were treated by autogenous anatomic reconstruction by endarterectomy. Endarterectomy was performed extra-peritoneally by the eversion technique. The operative technique and its advantages and disadvantages are discussed. Six patients had postoperative complications of acute anastomotic hemorrhage (two patients), would hematoma (two patients), and atelectasis (two patients). Sixty patients discharged with patient arterial reconstruction were followed up from 5 months to 17 1/2 years, with a mean follow-up of 53 months. There were no other vascular complications. Seventy limbs were at risk during this period, with an accumulative patency rate of 80.4% at 5 years and 71.4% at 10 years. There were 11 occlusions of the external iliac artery and one stenosis of the common femoral artery. Failures occurred mainly in the external iliac artery, which appears to be the limiting factor in the continued patency of endarterectomy. There were 18 deaths (30%). Nine deaths were attributed to the complications of arteriosclerosis. 