Segmental occlusive disease though limited to the popliteal artery gives rise to significant ischemic symptoms such that surgical treatment is indicated. Endarterectomy with vein angioplasty was the primary procedure in 76 patients (79 limbs) over the past 15 years. Augmentive lumbar sympathectomy was performed in 30 patients. Endarterectomy restoration was successful in 73 patients (76 limbs). Acute postoperative thrombosis occurred in six limbs, four were restored, one survived, one underwent delayed amputation. Long term failures developed in 18 limbs, four were restored, 11 survived without further treatment, and three were amputated. All limbs were classified according to stages of outflow obstruction and extent of endarterectomy; however, there was no meaningful pattern of correlation with failures except to note that amputations occurred only in advanced stage III obstructions. Thirty-two patients (43%) were restudied by arteriography. Cumulative patency rate for 79 limbs at risk at five years was 75.6%, at ten years, 58.5%. Restoration of popliteal patency can be accomplished by endarterectomy with results comparable to femoral-popliteal saphenous vein graft for more proximal lesions. Endarterectomy affords the advantage that a bypass procedure can still be performed in most failures as the long saphenous vein, not sacrificed initially, is still available.