To evaluate trends in vascular surgical activity in Finland, data were gathered from cross-sectional questionnaire surveys during three separate years. The material consisted of 1,658 (1976) and 4,887 (1992) procedures in Finland, and 1,039 (1988) and 1,212 (1992) in the Tampere region. In 1976 there was an annual mean of 350 vascular reconstructions per one million inhabitants, 660 in 1992, and 967 if also endovascular revascularisations were included. Sympathectomy was virtually vanished by 1992, thromboembolectomies clearly decreasing, carotid, aortic aneurysm and femorodistal surgery increasing and endovascular surgery emerging as a new major force, comprising of one third of all vascular activity. Vascular surgical activity appears to be strongly increasing, but the treatment pattern has markedly changed towards well-targeted endovascular and vascular interventions with a decreasing number of emergency operations and ill defined procedures like sympathectomies.