The aim of this retrospective study was to evaluate etiology, frequency and prognosis of the distal and severe arterial diseases of the upper limb treated in a vascular surgical unit. Between Jan. 1986 and Jan.1997, 34 patients, 22 males and 12 females, mean age 56 years (range 30 to 87 years) were followed in the vascular and thoracic surgical unit in Angers. Follow-up was 100% complete. Each patient was explored by selective angiography of the upper limb due to the critical characteristic of ischemia.19 patients (56%) had tissue loss. Among multiple etiologies, arteriosclerosis was found in 32% of the cases. When medical treatment was unsuccessful, a thoracic sympathectomy was attempted in 50% of the cases, and 21% of the patients had direct arterial surgery. Nine deaths, due to initial pathology, occurred during follow-up. Eight digitalis amputations were carried out whose two directly because serious necrosis. Severe arterial diseases of the upper limb represented 6, 4% of critical limb ischemia treated during this same period. At time, this study showed arteriosclerosis preponderance over systemic diseases, and the seriousness of cases referred to a vascular surgical center after unsuccessful medical treatment (J Mal Vasc 1999; 24: 368-372).