We have performed 82 operations on 79 individuals with occlusive disease of the subclavian or innominate arteries during the past 16 years. The left subclavian was occluded in 63, the right in nine, and the innominate in seven. Presenting symptomatology was neurologic in 29, arm ischemia in 24, and combined in 23. Blood pressure was reduced by 30 mm Hg on the involved side in all. An extrathoracic approach was used in 67 and a transthoracic approach in 15. Early mortality (20%) and morbidity (20%) were associated with the transthoracic approach. Long subcutaneous axilloaxillary and axillocarotid grafts are prone to thrombosis and skin erosion. Carotid-subclavian grafts used in 57 remain patent, are associated with a low mortality (1.5%), and do not develop “carotid steal.” When associated with vascular insufficiency of the lower extremity (44%) the brachiocephalic lesion should be corrected first.