Forty-nine patients underwent sixty-four procedures for the treatment of the thoracic outlet compression syndrome. Detailed history and careful physical examination are of paramount importance in diagnosing this disease. Our findings strongly suggest that a positive arteriogram is confirmatory evidence of the thoracic outlet compression syndrome. Two problems are identified as the source of unsatisfactory results in this series: poor selection of patients and the regeneration of rib and dense scar tissue with recurrence of compression symptoms. We favor the transaxillary approach to resection of the first rib because it provides satisfactory exposure for removal of the entire rib and utilizes a more cosmetically pleasing incision. Division of muscles, traction on nerves, and entrance into a body cavity are not required, operating time and hospital stay are shortened, and blood loss is minimized. Favorable long-term results were seen in 86 per cent of the patients treated.