Greater civilian use of firearms and improved transportation and resuscitation of the injured provided institutions with an increasing experience with subclavian vascular injuries. Patients (93) with subclavian vascular injuries are presented and 2 time periods are compared. Principles of management gained from the earlier experience were utilized with a decline in mortality to 4.7% among the patients admitted with a palpable pulse or blood pressure. Successful treatment as before lies in the recognition of the severity of the injury, rapidity of preparation for operation and adequacy of surgical exposure. Recent trends include an increased reliance on selective arteriography when the patient is stable, extensive use of the book thoracotomy as a primary incision, preoperative and intraoperative autotransfusion and a more frequent use of interposition grafting for vascular repair. Primary arterial repair was seldom accomplished; most patients required segmental resection with end-to-end anastomosis or interposition grafts.