AbstractThis article is divided into 4 sections which deal with changes in the management of short stenoses in the iliac arteries, the management of aorto‐iliac disease and the effects of concomitant myocardial ischemia, changes in the design of prostheses, and “multisegmental” disease. Myocardial ischemia may be apparent from clinical or electrocardiogram evidence, or it may be covert. The mortality rate after aortic bifurcation grafting may improve if patients with severe coronary artery disease are either refused operation or have a coronary bypass first. It was postulated over 10 years ago that increased porosity would encourage the formation of a functioning intima on the inner surface of a prosthesis. Since then, the fashion has been to use porous prostheses, and recent developments to offset the loss of blood at implantation are described. Methods of predicting which patients with multisegmental disease will require combined aorto‐iliac and femoropopliteal reconstructions are discussed in the light of the problem of early occlusion of aortobifemoral grafts.