Strictly speaking, internal medicine can only play a role in the prevention and control of risk factors, and there is no effective treatment for subclavian artery steal syndrome. However, if a patient’s subclavian artery steal syndrome is the result of atherosclerotic stenosis or occlusive disease of the proximal subclavian artery, the patient should receive lifelong medical antiplatelet therapy to reduce the risk of myocardial infarction, stroke, and other vascular causes that may lead to death. Fundamental to the treatment of subclavian artery steal syndrome is the restoration of collateral blood flow to the vertebral arteries, thereby relieving the symptom complex associated with central nervous system ischemia. Surgical procedures are the fundamental treatment for subclavian artery steal syndrome. The goal of surgical treatment is to restore collateral blood flow to the vertebral artery to relieve clinical symptoms. By restoring adequate blood perfusion to the affected arm, the need for collateral blood flow from the head and neck is eliminated during arm movements. (1) Endarterectomy Endarterectomy is an incision of the artery after control of the vessel to remove the patchy, diseased intima and internal elastic lamina to restore patency to the lumen. Since stenosis or occlusive lesions of the proximal left subclavian artery are mostly caused by the extension of the aortic arch plaque fast to the proximal left subclavian artery, when performing endarterectomy of the proximal left subclavian artery, a portion of the aortic arch must be blocked to ensure effective resection of the entire lesion; therefore, the procedure must be performed through an anterolateral opening of the left third rib space to obtain adequate exposure. For the proximal right subclavian artery, adequate exposure can be obtained through a transverse incision at the root of the neck without the need for a thoracotomy. This direct surgical intervention of the proximal subclavian artery was once of interest, but has largely been replaced by less invasive surgical approaches due to its high risk and complications. ②Extra-thoracic carotid and subclavian artery bypass The extra-thoracic carotid and subclavian artery bypass is performed by exposing the carotid and subclavian arteries through a transverse incision extending 5 to 7 cm laterally parallel to the clavicle through the superior sternal recess at the base of the neck, and a 6 to 8 cm polyester or polytetrafluoroethylene artificial vessel is usually used for the end-lateral anastomosis. This extra-thoracic carotid-subclavian artery bypass is simple, low-risk, with few complications and well-tolerated, and has largely replaced subclavian endarterectomy. (iii) Subclavian artery transposition The transposition is performed by anastomosing the subclavian artery to the lateral aspect of the common carotid artery, thus changing the origin of the subclavian artery. The procedure is performed through a transverse incision at the root of the neck and a subclavian artery-carotid artery end-lateral anastomosis is performed. The advantage of this procedure is that no artificial repair material is needed, but the procedure requires a large separation, especially when performing a left subclavian artery-left carotid artery end-lateral anastomosis with the possibility of damaging the thoracic duct. The long-term outcome of subclavian artery transposition is similar to that of carotid-subclavian artery bypass. ④ Axillary artery, axillary artery bypass Axillary artery-axillary artery bypass is performed using a graft to bridge between the right and left axillary arteries from a subcutaneous tunnel above the sternum. A prerequisite for the use of this procedure is that the contralateral axillary artery must be free of vaso-occlusive lesions. Because this procedure does not really surpass the subclavian artery graft, it is now rarely used unless the ipsilateral common carotid artery is too severely diseased to be used as a bypass vessel. Endovascular stenting Endovascular stenting is an emerging technique that has been developed in recent years. This technique has the advantages of being minimally invasive, safe, maintaining physiology and fast postoperative recovery. Endovascular stenting involves the implantation of a stent in the proximal subclavian artery to improve the blood supply to the affected arm and to treat subclavian artery steal syndrome.