Thefirst successful bloodvessel graft ina patient wasperformed byLexer, ofJena, inI912. Heresected ananeurysm ofthepopliteal artery andthenrestored continuity bya 13-cm. length ofsaphenous veintaken fromtheopposite leg. ByI913hewasable toreport that hehadresected three aneurysms ofthevessels ofthelower limb andrestored continuity ineachcasewithan autogenous veingraft. Twopatients werealive with patent grafts andonehaddied, possibly of cardiac failure, butwitha patent graft. After Lexer's pioneer workwithautogenous veingrafts sporadic reports ofsuccessful cases haveoccurred intheliterature, notable examples being those of Coenen, ofBreslau, whoinI9I3wasthefirst to useafree veingraft asamethod ofreconstructing theartery after theresection ofanarteriovenous aneurysm, andMurray, ofToronto, whoinI939 usedheparin forthefirst timeafter reconstructing thepopliteal artery withanautogenous veingraft. Thealternative tovein grafting isartery grafting. Anartery graft maybeautogenous, homologous orheterologous. The obvious limitations of supply render anarterial autograft rarely possible; heterografts ofalltypes seldom succeed andso oneisleft withthehomograft asthemostuseful typeofartery graft. Carrel inI908performed ona dogthefirst successful arterial homograft andhealsorealised thatan artery bankwas essential forartery grafting tobeapractical proposition inclinical practice. Hedevised amethod ofstoring arteries insaline ato°to40C. andused themethod successfully inexperimental animals, butitwasmanyyears before stored arteries were usedinman. Gross, Bill andPeirce inI949 developed thefirst humanartery bank;their methodofpreservation innutrient saline was a modification ofCarrel's methodofstorage. Theresults havebeenverygood, butthemethod hasonegreat disadvantage-the arteries cannot bekeptformorethansixweeks.Thismeans muchwastage andPeirce reports autilisation rate ofonly6percent.fromsucha bank.AtSt. Mary's Hospital weused tobankourarteries by freezing. Themethod which wasworked outby Hufnagel andEastcott wassimple, satisfactory andhadtheadvantage thatthearteries could be stored forlongperiods oralmost indefinitely. Butrecently we havebeenusingfreeze-dried arteries; these areevenmoresatisfactory, because theycanbestored foranindefinite period atroom temperatures andthesurgeon cancarry themin hisinstrument bagwithasmuchease asatubeof distilled water (Fig. i). Nowthatarteries canbebanked satisfactorily thesurgeon canuseeither anautogenous vein graft orahomologous artery graft toreconstruct thearteries ofhispatients. Theveingraft has manyadvantages; itisautogenous andtherefore survives after transplantation, anartery bankis unnecessary and,ifthesaphenous orexternal jugular veins areused,their losscauses little inconvenience tothepatient. Ontheother hand, veingrafts areunsatisfactory fortheaorta andits mainbranches because theydilate andtheyare technically moredifficult toinsert thanartery grafts. We useartery grafts fortheaorta andits major branches andprefer themforreconstruction oftheperipheral arteries because theyhaveless tendency tothrombose and,inspite ofthefact that theydonotsurvive transplantation, theresults appear tobebetter.