Laser‐assisted balloon angioplasty has the potential to reduce mortality and morbidity by replacing aorto‐femoral bypass operations in patients with occlusion of the iliac arteries. We present our early experience with 16 patients undergoing this procedure. using a Cardiolase neodymium: mum aluminum garnet (Nd: YAG) laser in the operating room. Initial recanalization was achieved in 14 of the 16 patients. Early re‐occlusion occurred in 4 patients, one of whom had a successful repeat laser angioplasty. This patient, together with the remaining 10 patients with successful initial recanalization remain patent at a mean follow‐up period of 10 months. There were no deaths or chest complications. Angiographically demonstrated luterial perforation occurred in 2 patients, neither of whom required operation on the perforated segment. We conclude that recanalization of the iliac arteries is possible and safe. The procedure is unlikely to replace aorto‐femoral bypass until the proportion of early failures is reduced. This may quire larger probes or the immediate placement of intra‐arterial stents following laser angioplasty.