The long-term results of 63 consecutive femoro-popliteal endarterectomies are presented and discussed. The average period of follow-up was 52 months. There were no per- or postoperative deaths. The early failure rate was 30 % (10 out of 63) and five-year patency was 26 %. Extremities with compromised inflow and/or outflow had a five-year patency of only 10 %, whereas five-year patency was 40 % for the remainder. Endarterectomies of short occlusions and a five-year patency of 38 %, while five-year patency for long occlusions was only 8%. Since five-year patency for even the optimal operative candidate (with only moderate ischemic symptoms, with short occlusions of the femoral artery, as well as with both good inflow and outflow) was not above 40 %, the authors conclude that endarterectomy is not suited for the treatment of femoro-popliteal occlusions.