¹KVC Kliniği, bKardiyoloji Kliniği Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, İstanbul Management of subclavian steal syndrome due to subclavian artery occlusion is surgical. Ipsilateral critical carotid occlusion accompanied by subclavian artery occlusion may complicate the planned surgical procedure. We detected ipsilateral critical carotid stenosis in a patient for whom operation was planned for left subclavian artery occlusion. In this patient, we performed the carotid anastomosis of the bypass graft in end to side fashion on the arteriotomy incision that was made for the endarterectomy instead of performing primary closure. By this way treatment of two distinct vascular pathologies was achieved concurrently by a single surgical operation. It is concluded that performing the carotid anastomosis of the carotid-subclavian bypass graft on the arteriotomy after carotid endarterectomy may be a favorable alternative for concurrent treatment of both pathologies in patients with subclavian artery occlusion accompanied by ipsilateral critical internal carotid stenosis. Keywords : Carotid artery diseases; subclavian steal syndrome; carotid stenosis