It was analyzed the results of the survey and surgical treatment of 110 patients with costo-clavicular syndrome (CCS). It was performed 131 decompression operations including 21 patients with two-sided surgery. It was done 96 combined selective cervico-thoracic sympathectomy surgeries in 76 patients with Raynaud's syndrome. There were 3 types of decompression operations: scalenotomy, I rib resection with transaxillary and supraclavicular accesses. It was shown that transaxillary rib resection is effective and pathogenetically grounded invervention in patients with combined and neurological forms of CCS despite some technical difficulties. Decompression effect is achieved in all 3 anatomically contracted compression sites. Scalenotomy with selective cervico-thoracic sympathectomy, neurolysis and arteriolysis is advisable for arterial form of CCS with secondary Raynaud's syndrome. Transaxillary resection of 1 rib is indicated for venous form of CCS. Differentiated approach to treatment of patients with different forms of CCS provides positive results in long-term period in 82.0% of patients. Recurrent symptoms in patients with Raynaud's syndrome after selective cervico-thoracic sympathectomy were observed in 18% of observations.