1. Thoracic Outlet Syndrome: Transaxillary Approach
Margaret Clarke Tracci, MD, JD 
Operative Techniques in Thoracic and Cardiovascular Surgery 
Volume 16, Issue 4, Pages (December 2011)
DOI: /j.optechstcvs
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2. Figure 1
Normal bony anatomy and neurovascular relationships of the thoracic outlet. a. = artery; m. = muscle; v. = vein.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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3. Figure 2 Common bony anomalies in thoracic outlet syndrome.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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4. Figure 3
Patient positioning and incision site for the transaxillary approach.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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5. Figure 4 Operative exposure provided by the transaxillary approach.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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6. Figure 5
Resection of the anterior scalene muscle, preserving the phrenic nerve.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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7. Figure 6
Division of the middle scalene, preserving the long thoracic nerve.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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8. Figure 7 Dissection of the inferior border of the first rib.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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9. Figure 8 Resection of the first rib using the Roos first rib shear.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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10. Figure 9
Completion of medial rib removal using the Kerrison rongeur may be, in the treatment of vTOS, accompanied by resection of the costoclavicular ligament, the subclavius tendon and muscle, and full venolysis.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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11. Figure 10
Completion of lateral rib removal using the Kerrison rongeur.
Operative Techniques in Thoracic and Cardiovascular Surgery  , DOI: ( /j.optechstcvs )
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