The English literature on extrathoracic procedures for aortic arch syndrome spanning the 19-year period 1962-1980 has been reviewed. Fifty publications reporting on 787 operations were selected for analysis. The overall results were excellent in terms of safety and long term symptomatic relief. Unilateral carotid-based operations appear preferable to longer crossover bypasses in the majority of patients. It is suggested that transthoracic reconstruction remain the approach of choice for innominate artery disease and multiple bilateral arch branch occlusions in good-risk patients.