Abstract Aim — to assess own experience of treatment of thoracic outlet syndrome followed by vascular complications. Material and methods. There were 27 patients (11 (40.7%) men and 16 (59.3%) women, mean age 32.2±4.5 years) with complicated forms of thoracic outlet syndrome. Vascular complications included thrombosis of subclavian artery (n=7) and vein (n=11), subclavian artery aneurysm (n=2), arterial embolism of the forearm (n=5) and fingers (n=2). Diagnosis was established considering clinical manifestations, compression tests data, characteristic anamnesis and survey data — sonography (n=27), X-ray imaging of cervical-thoracic spine with capture of the 1st rib and clavicle in two planes (n=27), angiography (n=16). Results. Medication followed by surgery for thoracic outlet syndrome per se was applied for thrombosis of subclavian vein, arterial embolism of fingers, hand and forearm with subcompensated circulation. Two patients with traumatic aneurysm of subclavian artery underwent delayed replacement of subclavian-axillary segment with antegrade thrombectomy. Treatment strategy for acute thrombosis of subclavian artery consisted of urgent retrograde thrombectomy followed by subclavian artery stenting in 1 case. Decompression procedure was performed either simultaneously with thrombectomy (in 6 cases) or as soon as symptoms of acute limb ischemia regressed within the same hospitalization (in 1 case). Brachioplexitis and wound suppuration followed by successful medication occurred in 2 cases postoperatively. Good outcomes were noted in 20 (74.1%) patients, satisfactory — in 6 (22.2%), unsatisfactory — in 1 (3.7%) patient. Conclusion. Timely diagnosis of thoracic outlet syndrome and additional cervical rib allows simultaneous or step-by-step elimination of acute limb ischemia and its cause with excellent outcomes avoiding the risk of recurrent thrombosis and embolism. Conservative therapy followed by subclavian vein decompression after 3—6 months is advisable for venous thrombotic complications.