Subclavicular approach to first rib resection.

As discussed by Urschel [13], 50 to 70 percent of patients with symptoms of thoracic outlet syndrome may be treated conservatively by nonsurgical methods. Patients who still have symptoms after years of such therapy are referred to us for surgical treatment. Failure to obtain symptomatic relief after scalenotomy alone [8] caused us to abandon this treatment. The advantages of the subclavicular approach to first rib resection are as follows: (1) The operation is easy and fast. (2) There is good visibility in the operative field. (3) The neurovascular bundle to the arm lies cephalad and out of harm's way. (4) The complication (infection) rate is very low. (5) The operation allows adequate resection of the first rib. (6) The operation allows the addition of upper extremity sympathectomy. The disadvantage is the position of the scar in a young woman, although lateral placement of the scar does not seem to cause much emotional trauma.