Subclavian steal syndrome occurs when there is stenosis of the subclavian artery proximal to vertebral artery. Vertebral artery originate from the subclavian artery just before the origin of internal mammarian artery and, the most common lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. This circumstance may cause diverse angina and neurological symptoms including vertigo, ataxia, visual disturbance and cerebral ischemia. Therefore, surgical reconstruction of the subclavian artery and vertebral artery should be done to relieve symptoms of ischemia. We present a patient who underwent vertebral artery transposition to thyrocervical artery concomitant with carotico-subclavian saphenous bypass due to subclavian artery and vertebral artery stenosis. Key words: Subclavian steal syndrome, vertebral artery stenosis, vertebral artery transposition, thyrocervical artery.