Upper extremity ischemic arterial disease is much less common than lower extremity ischemic arterial disease. There are many disorders that cause ischemia in the upper extremities. The clinical presentation of upper extremity arterial disease, broadly speaking is either acute or chronic. Acute upper extremity ischemia is mostly seen as a result of traumatic injuries or embolic occlusion. The clinical presentation typically is upper extremity pain, paresthesias, and, in advanced cases, motor dysfunction. The diagnosis can be readily established by clinical examination and confirmed by arterial ultrasound duplex assessment of the upper extremity by a hand-held device or point-of-care ultrasound or bedside ultrasonography. In cases of embolic occlusion, immediate anticoagulation should be instituted. Revascularization should be considered on an urgent basis especially in patients who exhibit signs of early motor dysfunction. Embolectomy has traditionally been performed via open surgical approaches. However, there are now emerging percutaneous embolectomy options that may obviate the need for surgery in many patients. Chronic upper extremity arterial ischemic diseases comprised of a wide group of disorders with varying clinical manifestations. Cases of subclavian artery disease are mostly asymptomatic but can present with arm claudication and occasionally, symptoms of vertebrobasilar ischemia. Hand ischemia manifests as pain and discomfort and in advanced cases with digital ulceration and gangrene. The causes are various, and the diagnosis and treatment of these disorders are tailored to the underlying condition.