Fifty-nine patients, 43 men and 16 women, 32 to 45 years of age (mean age, 40.9 years), underwent aortoiliac reconstruction between 1953 and 1968. Two died in the hospital. Six patients required additional surgery during hospitalization and 11 at a later time, either because of failure of aortoiliac reconstruction or distal arterial occlusion. Three patients underwent major amputation. Seventeen patients died two months to ten years after surgery. In 13, causes of death were related to the cardiovascular system. The average age of this group at death was 45 years. Forty patients are alive and have been observed from 1 to 16 years with a mean follow-up period of 5.1 years. Forty percent of survivors continue to have lower extremity arterial insufficiency. A significant number of patients requiring aortoiliac reconstruction in early life have a poor prognosis and limited life expectancy.