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Thoracic outlet syndrome (TOS) is an underdiagnosed and undertreated condition that occurs owing to neurogenic, arterial, and/or venous compression in the thoracic outlet. 1 There are two main surgical approaches to TOS decompression: transaxillary and supraclavicular. The supraclavicular approach has several potential advantages, including that it allows for complete anterior and middle scalenectomy, resection of cervical and first ribs, brachial plexus neurolysis, and vascular reconstruction. 1-4 The objective of this video guide was to demonstrate a comprehensive approach to supraclavicular TOS decompression.

A young woman presented with right-sided arterial and neurogenic TOS at a high-volume tertiary care TOS center. Signs and symptoms of arterial compression included arm fatigue with use, pallor, and absent radial pulse with provocative maneuvers. Neurogenic symptoms included hand and arm …