Surgery for Thoracic Outlet Syndrome

People with damage to an artery or vein are typically treated with a rib resection, which is surgical removal of the first rib. People who have neurogenic thoracic outlet compression may have a rib resection if physical therapy has not alleviated their symptoms.

Our expert vascular and thoracic surgeons collaborate to offer patients minimally invasive robotic-assisted surgery for a first rib resection. This innovative procedure, performed under general anesthesia, provides surgeons with superior visualization of all thoracic outlet anatomy and requires smaller incisions than conventional surgery.

During a robotic-assisted first rib resection, surgeons make three tiny incisions in the chest to directly access and widen the thoracic outlet to remove the rib and possibly the muscles attached to it. Surgery may involve removing scar tissue caused by repetitive use of an arm or shoulder that may be compressing adjacent nerves, arteries, veins, and muscles. Sometimes surgeons also remove the scalene muscles—which pass through the thoracic outlet—to reduce compression.

Surgeons then close up the incisions with dissolvable stitches. The procedure takes about 90 minutes. Most patients stay overnight in the hospital and go home the next morning. Recovery time varies, but most patients can return to normal activities at home the day after surgery. Return to exercise or physical therapy typically starts two to three weeks later.

Conventional rib resection requires making an incision above or below the clavicle or under the arm to access the rib. The surgeon cuts and removes the extra rib and closes the incision with stitches. Scalene muscles may also be removed. Surgery takes about two hours to complete and requires a one- to three-day stay in the hospital. Recovery may take several weeks, during which your doctor may recommend restricting activities.

Our vascular surgeons may perform minimally invasive procedures called balloon angioplasty or balloon venoplasty.

Balloon angioplasty helps open narrowed arteries in the arm and chest after a rib resection in people with arterial thoracic outlet syndrome. Balloon venoplasty opens narrowed veins in the arm and chest caused by venous thoracic outlet syndrome.

Using local anesthesia, vascular surgeons puncture the arm with a needle, then insert a catheter with an inflatable balloon at the tip into an artery or vein. They then guide the catheter to the narrowed space between your first rib and collarbone.

Procedures take 30 to 90 minutes, depending on the severity of the blockage. Typically, you return home on the day of the procedure.