Since 1981 intraoperative balloon dilatation has been performed in 78 patients suffering from occlusive arterial disease of the lower extremities. In 34 patients the proximal iliac stenosis was dilated (common iliac artery: 15 and external iliac artery: 27) in association with a femoro-popliteal reconstruction. In 44 patients, the femoro-popliteal segment distal to an ilio-femoral reconstruction was dilated. In the early postoperative period (0-30 days) there was no reocclusion in the group of proximal dilation. In the other group, where the out-flow tract was dilated, in one case femoral amputation, while in another patient reoperation was necessary because of early reocclusion. The combining intraoperative balloon dilatation with surgical reconstruction may decrease the risk, and simplify the management of patients with multiple vascular lesions and it is valuable adjunct to vascular surgery to improve inflow or outflow.