Forty-four years of experience with arterial embolism is reviewed. Patients presenting with this problem are increasingly older, more frequently female, and usually have atherosclerotic coronary artery disease. Atrial fibrillation is found in a high percentage of these patients. Mortality after embolism is decreasing but remains high (25 percent). Limb salvage is usually achieved (87 percent) but has improved little since the balloon embolectomy catheter became available. Prompt treatment, careful patient selection for operation, and anticoagulation remain the keys to successful outcome in the management of patients with arterial embolism.