THE THORACIC outlet syndrome is a group of neurovascular symptoms in the neck, shoulder, arm, or hand related to compression of the subclavian vessels and brachial plexus. This condition has been recognized under a variety of names, the most familiar of which is the scalenous anticus syndrome.1 In 1956, Peet et al suggested the term "thoracic outlet compression syndrome" to include all of the recognized syndromes which are related to pressure on the neurovascular structures supplying the upper extremity.2 Scalenotomy has been the most popular surgical therapy until recently. Because of the significant failure rate with scalenotomy, attention has currently shifted to removal of the first rib. Resection of this rib for relief of neurovascular compression dates back to 1910.3 Scattered reports of good results from first rib resection appeared in the literature during the ensuing 50 years but received little attention.4-6 In 1962, Clagett revived