In this report we shall describe a 34-year old woman who presented with signs and symptoms of ipsilateral subclavian steal and thoracic outlet compression syndromes. The diagnosis was confirmed by arteriography and measurement of nerve conduction velocities. Via a single approach, the first rib was resected, the left subclavian artery was ligated at its takeoff, and flow was re-established with a woven Dacron graft. Two years postoperatively, the woman has equal and full pulses and blood pressure bilaterally, good strength, and no evidence of muscle atrophy.