Since December 1986, 140 laser angioplasty procedures have been carried out using a pulsed Nd:YAG laser (Lumonics Ltd. Rugby, UK). The laser produces 100 microsecond(s) ec pulses at a wavelength of 1064 nm and a repetition rate of 10 Hz. All procedures were carried out for critical ischaemia or severe claudication in patients who had complete occlusion of the superficial femoral artery (SFA). All occlusions were over 5 cm in length or previous failures of balloon angioplasty and would otherwise have proceeded to bypass surgery. The occlusion was approached percutaneously via the ipsilateral femoral artery and successful recanalization was followed by balloon dilatation. Problems with access were encountered in 18% of the procedures, about half of which were subsequently repeated with successful access. There was failure of recanalization in 26% of the cases, five due to vessel perforation. These did not result in clinical sequelae. Early occlusion (< 24 hours) occurred in nine cases, most being related to severely ischaemic limbs with very poor run-off. Three of these were salvaged with thrombolytic therapy. We have meaningful follow-up of those cases where we were successful. Forty-four patients remain patent, at a mean of 30.4 months post-procedure (range 3 - 47 months). Of the 19 patients who reoccluded, (mean 12.1 months, range 1 - 26 months), seven had bypass grafts, three underwent amputation (all three presented with rest pain), two had repeat laser procedures, and seven were treated conservatively. Thirteen percent of the patients have died, chiefly from cardiovascular disease elsewhere. Overall, continued patency has been achieved in 32% of limbs considered for laser treatment, but this rises to 60% of all initially successful procedures. In conclusion, laser angioplasty may avoid the need for vascular surgery in a significant number of patients.