Current experience in the management of upper-extremity arterial injury in a Level I trauma center between 1992 and 1994 is reported. Arterial trauma was seen in 21 of 643 (3.3%) patients admitted with upper-extremity injury. The mechanism of injury was penetrating in 15 of 21 and blunt in 6 cases. Patient characteristics were: 18 of 21 male, mean age 28, left upper extremity 12 of 21, and 4 patients in shock. Preoperative angiography was performed in 12 of 21 cases (5 of 6 blunt and 7 of 15 penetrating). Involved arteries included: brachial (10), axillary (5), radial (3), and subclavian (3). Associated injuries were common: nerve (9), bone (7), and vein (5). Twenty patients were explored; 18 of 20 underwent arterial repair (16 graft, 2 primary repair), and two proximal arteries were ligated. One intimal flap in the subclavian artery was observed, with a good result. Nerves were repaired in four cases, all with transection, and in four cases there was neurologic deficit without focal transection and no repair was performed. One patient died before his nerve injury could be repaired. Most venous injuries (four of five) were ligated, and three patients with blunt arterial injury underwent forearm fasciotomy. Immediate limb salvage was 100 per cent; there was one in-hospital mortality (4.7%) from exsanguination, and there was one persistent clinically significant late motor nerve deficit. Mean follow-up was 94 days (range, 0-305 days). Upper-extremity arterial injury often can be managed without angiography, particularly in cases of penetrating trauma. Good results can be anticipated with prompt arterial and nerve repair combined with selective use of venous reconstruction and fasciotomy.