When performed properly, a transposition is the most efficient and most durable procedure for reconstructing the subclavian artery for proximal occlusive disease or to extend the landing zone in the aortic arch prior to endovascular therapy for thoracic aortic pathology. The proximal subclavian artery, on the right or on the left, is approached quite differently than it is for a bypass procedure. The technique is described in detail here. There are very few contraindications to transposition, the advantages over the alternate options are many, and it can be the approach of choice in the vast majority of patients.