First rib resection

First rib resection is a surgical procedure used in humans to treat thoracic outlet syndrome (TOS) and Paget–Schroetter disease.

First rib resection is indicated for venous, arterial, and neurogenic TOS.

[1] In all cases, the goal of the operation is to increase the dynamic space between the chest wall and the clavicle, through which the subclavian vein, artery, and the brachial nerve roots pass.

[2] The first rib may be approached several different ways: from above the clavicle in an inferior direction (infraclavicular), from above the clavicle (supraclavicular), from the posterior neck, and from the armpit medially (transaxillary).

For venous thoracic outlet syndrome, removal of anterior scalene muscle (scalenectomy) and freeing up scar tissue around the subclavian vein (venolysis) are often also performed.