Iliofemoral endarterectomy (EA) is now considered by most vascular surgeons to be an obsolete technique that is difficult and unreliable. The purpose of this retrospective study was to reassess the place of iliofemoral EA on the basis of long-term outcome in our experience. From 1982 to 1995, we performed a total of 121 iliofemoral EA procedures on 98 patients with a mean age of 57 years. The anatomical presentation involved iliac occlusion in 55 cases and complex iliac stenosis in 63. The indication for treatment was critical ischemia in 28 cases. Operative mortality was nil. Major amputation was required in only one patient because of contralateral thrombosis during the procedure. Postoperative thrombosis requiring early thrombectomy occurred in five cases. At 5 and 10 years, actuarial rates were 77.6% and 61.3%, respectively, for survival, 98.3% and 90.1%, respectively, for limb salvage, 78.9% and 65.1%, respectively, for primary patency, and 88.2% and 73.8%, respectively, for secondary patency. On the basis of these findings, we consider iliofemoral EA to be a viable alternative to iliac bypass in patients ineligible for transluminal angioplasty.