Objectives: to report the long term results of remote superficial femoral artery endarterectomy (RSFAE) with the MollRing Cutter ® for the treatment of long segmental SFA occlusive disease. Design: retrospective open study. Patients and Methods: from March 1994 to August 2000 183 RSFAEs were performed in 164 selected patients (105 males, 120 procedures) with a median age of 63 years (43-84 years). Indications for operation were disabling intermittent claudication in 129 procedures (70%), rest pain in 20 procedures (11%), and limb salvage in 34 procedures (19%). Follow up consisted of clinical evaluation, ankle-brachial index measurements and duplex scanning. Results: the mean follow-up time was 29.3 months. The mean length of the endarterectomised SFAs was 31 cm (range, 17-45 cm). The five year cumulative primary patency rate by means of life table analysis was 37.8 ± 6.67% (SE). Percutaneous transluminal balloon angioplasty and surgical re-intervention were performed in twenty-nine and four patients respectively resulting in a primary assisted patency rate of 47.9 ± 6.27%. Limb salvage was achieved in 30 of the 34 patients. Females had a statistically significant lower primary patency rate, i.e., 26 vs 45% ( p -value = 0.01). Conclusions: the long term results of remote SFA endarterectomy show that it is a safe, effective and durable, minimally invasive procedure. It also leaves open all other options for conventional bypass procedures. The five-year primary patency rate is at least similar to prosthetic above-knee bypass surgery. Eur J Vasc Endovasc Surg 25, 583-589 (2003)