Since 1981 intraoperative balloon dilatation has been performed in 78 patient suffering from occlusive arterial disease of the lower extremities. The indications were claudication in 32, and limb salvage in 46 patients. In most of the 34 patients in whom a proximal iliac stenosis was dilated in association with a femoro-popliteal bypass (10 patients), endarterectomy (19 patients) or profundoplasty (5 patients), the ankle arm index returned to near normal immediately after the procedure. In 44 patients, the femoro-popliteal segment distal to an ilio-femoral reconstruction was dilated. The follow-up period ranged from 1 to 60 months with an accumulated patency rate of 97.6% in aortoiliac and 60.2% in femoro-popliteal segment at 5 years. Fourteen patients were dead at five years after the intervention from concurrent cardiac disease. Balloon angioplasty is a valuable adjunct to vascular surgery either to improve inflow or outflow in association with surgical reconstruction.