The present work was done to determine the prevalence of peripheral macrovascular disease of the upper extremity and the associated risk factors among systemic sclerosis (SSc) patients. Narrowing and vessel wall thickness of large arteries of upper limb (axillary, brachial, radial and ulnar) were evaluated and investigated by Doppler ultrasound to assess macrovascular disease in 23 SSc patients. Ten out of 23 SSc patients (43.5%) had abnormal vessel wall thickening compared to none of the controls. The radial artery was most commonly affected in 34.8% of the cases, then the brachial and ulnar arteries each in 26.1% and the axillary artery in 8.7% of the cases. The mean disease duration and skin score were statistically significantly higher in SSc patients that have abnormal vessel wall thickening. Positive significant correlation of the brachial vessel intraluminal diameters with HDL and inverse correlation of the ulnar vessel intraluminal diameters with triglycerides were detected. We can conclude that digital ischemia and ulceration in the patient with SSc may be due to large vessel as well as to small vessel disease. Doppler ultrasound is a valid, reliable, and convenient method in the detection and evaluation of macrovascular disease in SSc. Systemic sclerosis patients with higher skin score, increased diastolic blood pressure, longer disease duration, elevated triglycerides, and lowered high density lipoproteins should be considered at high risk for the development of macrovascular disease. There is an increased prevalence of macrovascular disease in SSc. Moreover, optimal management of the patient needs to take this into account is an important key point for the clinician.