The two methods used to reconstruct visceral arteries obstructed by atherosclerosis, endarterectomy and prosthetic bypass are illustrated in two separate patients. The surgical approach in the first, using medial visceral rotation and a thoracoretroperitoneal exposure, allowed transaortic celiac and superior mesenteric thromboendarterectomy. The technique employs a trap-door aortotomy and extraction endarterectomy. Patency of the reconstruction is verified during the procedure with a duplex scanner, which is shown. The second patient had a transabdominal, transcrural approach to the supraceliac sub-diaphragmatic aorta. A prosthetic knitted bifurcation graft was attached to the anterior surface of the supraceliac aorta and the limbs attached to the celiac and superior mesenteric arteries beyond their disease. The duplex scan was again useful in assuring patency.