The results of transaxillary excision of the first rib for thoracic outlet syndrome are reported. During a 3-year period, 40 transaxillary rib resections were performed on 32 patients. The symptoms in 33 limbs were completely relieved and in a further four symptoms were improved. These results confirm that transaxillary excision of the first rib is the operation of choice in the management of thoracic outlet syndrome.