DiscussionImprovements in technique appear to allow endarterectomy to be performed below the inguinal ligament with a reasonable initial success rate. In this series it is 95 %. If the occluded segment is of limited length this operation is preferred to the femoro-popliteal bypass graft. In practice, however, the arteriogram often gives an inadequate assessment of the length of artery requiring endarterectomy. This is frequently much longer than is apparent radiologically.When the superficial femoral artery alone is the site of operation, the common femoral and popliteal arteries must be carefully scrutinized on the arteriograms. If any doubt exists about their adequacy they must be explored at operation, because disease above or below the superficial femoral endarterectomy may cause primary failure. When aorto-iliac occlusive disease is present in addition to disease below the inguinal ligament endarterectomy can be performed simultaneously above and below the inguinal ligament. In short occluded segments we prefer to use direct endarterectomy without stripping. In long occluded segments, if the atheromatous material separates easily, we use a stripper. Arteries are stripped under direct vision to ensure that no damage is done to the outer wall of the vessel, and any serious resistance to stripping requires a further arteriotomy. In all cases, whether stripping is done or not, the lowest limit of the endarterectomy is directly visualized through an arteriotomy, and the distal intima anchored where required.We believe that any arteriotomy distal to the common femoral artery should be closed with a vein or Dacron patch, and some common femoral arteriotomies also require this. Some surgeons recommend arteriography on the operating-table, after stripping to ensure that no atheromatous fragments are left in the arterial lumen (Wylie, Binkley, and Albo, 1964 Studies with Complamin, a Nicotinic-acid-Theophylline Ester, as a Fibrinolytic Agent G. P. McNICOL,* M.D., M.R.C.P.ED., M.R.C.P.GLASG.; A. S. DOUGLAS,* M.D., B.SC., F.R.C.P., F.R.C.P.GLASG., F.R.C.P.ED. Brit. mned. Y., 1965Brit. mned. Y., , 1, 1149Brit. mned. Y., -1153 Though the feasibility of thrombolytic therapy with fibrinolytic enzymes has now been demonstrated-for example, Fletcher et al. (1959)-the expense involved in the preparation of suitable enzymes and the difficulties in laboratory control of enzyme therapy have stimulated a search for non-enzymatic agents which when administered might stimulate production or release of fibrinolytic enzymes in the body. One such substance is nicotinic acid, which, fibrinolytically inert in vitro, was discovered by Meneghini and Piccinini (1958) and Weiner et al. (1958) to have the property of inducing intense but transient fibrinolytic activity when injected intravenously in man. Because of the short duration of the fibrinolytic response and the rapid development of resistance, attempts have been made to provide modified preparations of nicotinic acid with enhanced activity, and it is the purpose of this paper to d...