Aberrant subclavian artery (ASA) is the most frequently encountered congenital anomaly of aortic arch. The ASA aneurysms are rare but potentially lethal disease, it has been recognized that the presence of an aneurysm of an ASA itself is an indication for surgery. We experienced 4 cases with ASA during the past 23 years. All cases were male. Their ages ranged from 51 to 73 years old. Three patients had a right-sided aortic arch. Among the 4 patients, only 1 underwent total arch replacement, but the other 3 patients could be followed conservatively for 1, 7 and 23 years, respectively. We reviewed the problem of the diagnosis and treatment of the ASA including surgical indication.