The Supraclavicular Approach to Decompression of Thoracic Outlet

Surgical decompression of the thoracic outlet along with treatment of the involved nerve or vessel is the accepted treatment modality when indicated. While neurogenic thoracic outlet syndrome (nTOS) is often operated via the axillary approach and venous TOS (vTOS) via the paraclavicular approach, arterial thoracic syndrome is almost always operated via the supraclavicular approach. The supraclavicular approach provides excellent access to the artery, brachial plexus, phrenic nerve and the cervical and/or first ribs along with any bony or fibrous or muscular abnormality that may be causing compression on the neurovascular structures. Even for nTOS, where the axillary approach offers good cosmesis, the supraclavicular approach helps adequate decompression while preserving the first rib. This approach may also be sufficient for thin patients with vTOS. For aTOS, a supraclavicular incision usually suffices for excision of bony abnormality and repair of subclavian artery.