Summary1. A series of 40 reconstructive operations on 36 patients for aorto‐iliac stenosis is presented. The stenotic lesions were divided into 2 groups:(a) Liriche syndrome (15);(b) isolated stenotic lesions elsewhere in the aorto‐iliac system (21).The differential diagnosis of these 2 groups on clinical grounds has been discussed.2. A follow‐up of the 40 operations has been performed over a period of six years. Twenty‐four of these operations were endarterectomies while the remaining 16 were arterial grafts. Only 50 per cent. of the grafts are patent at the present time while 92 per cent. of endarterectomies are working. In our hands the results of the latter operation are so superior that we tend to perform it in preference to grafting, where possible.3. The mortality rate (3 to 5 per cent.) for these operations is surprisingly good considering the magnitude of some of these procedures and the fact that often the patients are not first‐class operative risks. However, post‐operative complications have been numerous and include pneumonia (6), pulmonary embolus (4), ileus and burst abdomen (3), incisional hernia (1), adhesive obstruction (2) and superior mesenteric artery thrombosis (1).A transverse subumbilical incision has been used in the last 10 cases and none of these patients has ruptured their wounds, This incision gives a good exposure and appears to heal more securely than paramedian incisions.4. The symptom of impotence in cases of Liriche syndrome has been investigated. In this series 4 out of 10 patients (40 per cent.) questioned complained of either partial or complete importence. This figure is roughly similar to other published series. To our surprise only one of these improved following operation, in otherwise successful results. Inaddition, 2 of the other patients who did not complain of impotence before operation developed this symptom afterwards.Although impotence in Leriche syndrome may be due to inadequate blood supply to the pelvis, its incidence after operation suggests this may be due to disruption of the pelvicnerve plexus a