Arterial revascularization and venous ligation procedures have been introduced within the past 2 decades. Each procedure has in common with the other the fact that initial applications of the operations were widespread among the population of men with vasculogenic erectile dysfunction. In each case, disappointing long-term results led to more limited use of surgery targeting specific groups that clearly would benefit from the procedures. The wider application of these procedures in vasculogenic erectile dysfunction is not supported by the available results. The Clinical Guidelines Panel of the American Urological Association supported this view in 1996 after a meta-analysis of literature reports and declared that venous and arterial surgery was not justified in routine use, especially in patients with arteriosclerosis. Further studies are likely to refine patient selection but are unlikely to expand the therapeutic use of these procedures.