Effective treatment of arterial thoracic outlet syndrome includes early recognition and timely correction, with sufficient decompression of the thoracic outlet. A 56-year-old female suffered recrudescent right upper extremity ischemia due to thromboembolic event, raising suspicion for arterial thoracic outlet syndrome and prompting further imaging studies for confirmation. Decompression of the thoracic outlet by first rib resection and scalenectomy, followed by stenting of the diseased subclavian artery, allowed for resolution of arterial thoracic outlet syndrome.