In the last 10 yaers, four patients with aneurysms of the supraortic trunks and the internal carotid artery have been operated in emergency at Department of Vascular Surgery of University of Bari. The first case was a mycotic aneurysm of the carotid byforcation, the second an aneurysm of internal carotid artery interesting the retrofarynx, the third a postoperatory pseudoaneurysm of common carotid in a patient affected by Takayasu’s disease and the last an atherosclerotic aneurysm of the innominate artery. Clinical picture suggested an immediate surgical treatment in all patients. Different procedure were used depending on size and localization of each lesion. Results in all cases have been satisfactory. The aneurysms of supraortic trunks and of internal carotid artery are very rare; therefore when clinical picture is dramatic or quickly worsening, emergency treatment is mandatory in order to reduce mortality risk and minimizer complications.