The purpose of this report is to examine the contemporary indications for diagnostic carotid arteriography and evaluate its utility and safety when performed by vascular surgeons. The records of all patients having selective carotid arteriography from September 2000 through March 2002 at our institution were reviewed. One hundred sixty-four consecutive patients had selective arteriography of the extracranial carotid arteries for the following indications: hemispheric symptoms with stenosis <80% by duplex ultrasound (20.6%), suspected brachiocephalic trunk stenosis (15.8%), unclear anatomy by duplex (10.3%), recurrent carotid stenosis (10.3%), symptomatic high-grade (>80% by duplex) internal carotid stenosis (9.8%), ipsilateral internal carotid artery occlusion (7.1%), bilateral high-grade internal carotid artery stenoses (7.1%), vertebral-basilar ischemia (7.0%), contralateral internal carotid occlusion (5.4%), duplex ultrasound from a nonaccredited vascular laboratory (3.3%), and evaluation of nonatherosclerotic carotid disease (3.3%). There were no transient ischemic attacks, strokes, or deaths related to the index procedure. Selective angiography of the extracranial carotid arteries remains an important adjunct in the evaluation of patients with carotid disease. This procedure can be performed safely by vascular surgeons.