Thoracic outlet syndrome: first rib resection

Surgical treatment for thoracic outlet syndrome involves resection of the first rib (or a cervical rib) to resolve compression in the costoclavicular space. Depending on the structure involved (ie. brachial plexus, suclavian artery, subclavian vein) it may be necessary to perform adjunctive vascular reconstruction. Three approaches for first rib resection are described. Transaxillary first rib resection is the most commonly performed approach. The supraclavicular approach may be preferred for arterial thoracic outlet syndrome. For vein reconstruction in venous thoracic outlet syndrome the infraclavicular approach is often more appropriate. Clinical success is obtained in the majority of patients, with slightly more variable results for the neurogenic thoracic outlet syndrome. Severe complications are rare.