A 7-year experience with 502 patients undergoing abdominal aortic reconstruction was reviewed to determine the incidence of intestinal ischemia and the clinical, anatomic and technical factors associated with this complication of aortic surgery. The other complications during the 30-day postoperative period were also collected. A total of 7 (1.4%) patients had intestinal infarction. Of these, colon necrosis occurred in 4, and 3 patients had necrosis in the superior mesenteric artery (SMA) territory. The occurrence of intestinal infarction after operation for ruptured aneurysm was 3.9% (4 patients) and for intact aneurysm 1.3% (3 patients), respectively. None of the 174 patients operated on for aortoiliac occlusive disease developed intestinal infarction. The development of colon necrosis after operation for ruptured aneurysm was mostly in relation to shock and diminished tissue perfusion. Suprarenal aortic clamping with subsequent SMA embolization, prolonged aortic clamping time, and a sporadic thrombosis of the SMA were responsible for small bowel necrosis. In 4 of 7 patients (57%) intestinal infarction led to death. An overall 30-day mortality was 18% (91 patients). Four per cent of these deaths were due to intestinal infarction.