Fourteen patients with localized atherosclerotic obstruction of the subclavian artery were found to have considerable variation in symptoms. Seven patients had ischemic symptoms of the upper extremity, three patients manifested only vertebral-basilar insufficiency, and four had combined symptoms of cerebral and arm ischemia. The most consistent physical finding was a difference in blood pressure in the upper extremities of 20 mm Hg or more. Arteriographic visualization of the aortic arch branches was essential for evaluation and planning operative treatment. Reconstruction of the subclavian artery was possible in ten of the 11 patients operated upon, all of whom obtained a good result. Endarterectomy, often with a patch graft, was used in nine patients, while a free vein graft was needed in one with a retro-esophageal subclavian artery.