Trauma involving the subclavian and axillary arteries is relatively infrequent. However, it can result in devastating functional disability of the upper limb due to significant and permanent associated neurologic deficits. Uncertainty exists in relation to certain aspects of therapeutical management of patients with trauma of the upper limb. Although decision pathway and algorithms have been proposed by several authors, the indications for surgery remain uncertain and not established. Two main points seem to be the most important determinants of the therapeutical strategy; first the viability of the limb and second the accurate determination of the vascular and nerve damage. We present a patient with a traumatic disruption of the subclavian artery and vein and concomitant brachial plexus injury following a road traffic accident. We highlight the role of accurate diagnosis to avoid life and limb-threatening complications from missed diagnosis. Also we review the recent literature emphasizing the therapeutical strategy and the role of conventional surgical repair and endovascular treatment.