First rib resection for vascular complications of thoracic outlet syndrome

The surgical approach to vascular complications of the thoracic outlet syndrome remains controversial. When present, removal of a cervical rib alone has produced disappointing results. Our experience of 29 consecutive first rib excisions over a 5-year period is presented. Of 20 cases with uncomplicated subclavian artery compression 19 were cured, and of six cases with aneurysm or thrombosis five were improved. Of 12 cases with neurological symptoms nine were cured and two were improved. It is suggested that first rib excision is the essential primary treatment for patients with arterial symptoms due to thoracic outlet syndrome.