Recurrent arterial and new-onset neurogenic thoracic outlet syndrome as a complication after previously inadequately excised first and cervical ribs.

Thoracic outlet syndrome commonly presents with the neurogenic subtype and can be caused in rare circumstances by an anatomic abnormality such as a cervical rib, for which surgical excision is the mainstay of management. An inadequately excised first or cervical rib can result in recurrent symptoms. We have reported the case of a 30-year-old woman who had presented with symptoms of right recurrent arterial and neurogenic thoracic outlet syndrome. She underwent repeat right-sided first rib and cervical rib resection with brachial plexus neural lysis and right carotid-axillary bypass via a combined supraclavicular and infraclavicular approach. At 12 months of follow-up, improvement in her symptoms was noted.