Seventy-one patients with aorto-iliac occlusive disease and associated renalartery stenosis were operated on at the Mayo Clinic. Of these, 65% (46) had hypertension and 18% (13) had chronic renal failure. Revascularization of the lower extremities was performed with bifurcated, knitted Dacron prostheses in all cases. Endarterectomy of the origin of the renal arteries, from inside the aorta, was the most frequent method used to revascularize the kidneys (49 cases). The operative mortality was 6% (four patients). After a mean follow-up of three years, 81% (58) of the patients had significant benefit from revascularization of the lower extremities, and 46% (33) of the hypertensive patients had normal blood pressure. Eight other patients were normotensive when taking a diuretic. The most significant postoperative complication was renal failure, which occurred in 12 cases; it was transitory in six of these.