Upper extremity artery disease due to atherosclerosis is mostly situated at the level of the brachio-cephalic trunk, and the subclavian and axillary arteries. When clinically suspected, it can be assessed by DUS, CTA or MRA. In most asymptomatic patients, medical treatment is the option of choice. Revascularization can be proposed when: severe/disabling symptoms, bilateral stenosis, stenosis with ipsilateral arteriovenous fistula for dialysis, patients planned for coronary artery bypass graft surgery or those already operated on with ipsilateral internal mammary artery grafted to coronary arteries with evidence of myocardial ischaemia. When revascularization is considered, both endovascular and open surgical options can be proposed, according to lesion characteristics and patient’s risk.