We describe and present the results of our novel technique for eversion endarterectomy of the external iliac artery (EIA).For our prospective follow-up study, antegrade eversion endarterectomy (AEEA) of the EIA was mostly performed as a bail-out procedure, if (endovascular-assisted) remote endarterectomy from the groin had failed. Postoperative clinical and hemodynamic changes were reported according to the recommendations of the Society for Vascular Surgery. To evaluate the data, we used the Kaplan-Meier product limit method.Thirty patients (mean age 65.5 years) underwent AEEA on 33 EIAs for atherosclerotic occlusive disease over a 10-year period. The mean follow-up was 50 months. The primary technical success rate was 100%. The 30-day mortality was 0. There were no early occlusions. Two patients required redo surgery for retroperitoneal haematomas. Postoperative improvement was marked in 30%, moderate in 64% and minimal in 6%, explained by 21 (64%) concomitant occlusions of the superficial femoral arteries. The 1-, 3- and 5-year primary patency rates were 100%, 96% and 90%, and primary assisted patency rates were 100%, 96% and 96% respectively. Fourteen patients (47%) died during the long follow-up period from unrelated causes.AEEA is a safe autologous surgical technique with promising results.