Background: Neurovascular compressive thoracic outlet syndrome requires early decompression by releasing the compressive element. In the presence of post stenotic subclavian artery aneurysm with distal embolism surgical option for critical ischaemic upper limbs should be optimized. The option of excision of aneurysm with end to end anastamosis or reconstruction with interposition graft is not a promising option in long term patency. We successfully managed a young girl with post stenotic subclavian aneurysm by thoracic outlet decompression and reduction subclavian angioplasty.Clinical Profiles: 24 years old Lab Technician presented with numbness over the medial aspect of the right forearm for 2 years, pain for the past 6 months, difficulty in performing day to day lab work with increasing in intensity of pain on hand elevation. Clinical examination suggestive of thoracic outlet syndrome as a result of cervical rib with right subclavian artery aneurysm. Distal limb pulses not palpable. Doppler revealed stenotic subclavian artery with post stenotic dilation and distal flow damed. No reformed flow in the axially, brachial, ulnar and radial arteries. Angiogram revealed post stenotic true aneurysm of 2.5 x 2 cm with intramural thrombus. Distal vessel not visualized.Management: She was takenup for right thoracic outlet decompression with subclavian artery reconstruction under GA by right supraclavicular approach phernic nerve and brachial plexes well protected, cervical rib excised in toto. Aneurysmal sac opened with proximal and distal control. In view of the sacular nature of the dilatation, and well preserved intima of the adjacent arterial wall subclavian artery reconstructed by excision of the aneurysmal sac with linear closure procedure completed with right brachial embolectomy.Results: Post operative period minimal brachial palsy was present axillary, brachial and ulnar pulse well felt. 6 months follow up review satisfactory Doppler examination shows good flow in the right upper limb arteries.

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