Profundaplasty has been performed on 58 limbs (45 primary and 13 secondary) in 45 men. Thirty-four of these had incapacitating claudication, 14 rest pain, and 10 either gangrene or ischemic ulceration. In 19 treated by profundaplasty alone there were no deaths but three subsequently had amputation for ischemic pain. In 39 with profundaplasty plus a proximal operative augmentation there were two (6.7%) operative deaths and one (3.4%) late death but only one extremity had to be amputated. Radionuclide flow studies confirmed physical and arteriographic findings. After profundaplasty alone and profundaplasty plus aortofemoral bypass there was moderate increase in calf blood flow but in only those with a patent superficial femoral did the flow studies return to normal. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.