Acute bleeding of the upper gastrointestinal tract found in patients with arterial occlusive disease lead us to analyse the coincidence of arterial occlusive disease and pathological changes of the upper gastrointestinal tract. While waiting for reconstructive vascular surgery between 1986 and 1992 420 patients underwent esophago-gastro-duodenoscopy for preoperative risk assessment. In 59% endoscopy revealed pathological findings in the upper gastrointestinal tract. Inflammation was found in 61.6% of the patients, in 15% gastric ulcer. Patients with gastrointestinal symptoms had no significant more pathological findings in gastroscopy (p = 0.1). We excluded 9.3% patients from primary elective vascular surgery because of their severe pathological findings. 19 patients were operated on their gastrointestinal disease at first. In 7 patients we found an unknown carcinoma of the stomach. 5 patients got a resection of the stomach, in 2 patients an operation was unable. The diagnosis and therapy of risk factors are a major objective in the treatment of arterial occlusive disease. The results of the study stress the necessity of routinely performed endoscopy in patients awaiting vascular surgery. Beside a preoperative risk assessment this will lead to a lower incidence of serious gastrointestinal complications postoperatively.