One hundred seventy-five patients underwent aortic aneurysm replacement from 1970 to 1977, and these patients were reviewed retrospectively as to the need for further aortic surgery because of progression of atherosclerosis or aneurysmal disease. A 99% (174 of 175) follow-up was obtained. Eighty-six patients had tube graft replacement operations. Selection of tube graft replacement as opposed to other operative techniques included physical examination, documentation of segmental pressures by Dopper studies, and aortography. Seventy-three percent of all patients undergoing aortic aneurysm replacement had angiography performed before surgery to demonstrate the location of the aneurysm as well as evidence of occlusive disease. Of the eighty-six patients with tube graft replacements (mean follow-up 4.86 years +/- 2 years), two patients required aortobifemoral grafting--one for iliac stenosis, the other for an occluded iliac artery secondary to a thrombosed femoral aneurysm. Only 6 of the 86 patients who underwent tube graft replacement developed symptoms of claudication. None of these patients required operation. This retrospective study demonstrates that placement of a tube graft for aortic aneurysm is a reliable operation in carefully selected patients. Few of these patients require repeat aortic surgery for occlusive or aneurysmal iliofemoral disease. Extensive follow-up of tube graft patients is discussed.