Is it possible to do a full scalenectomy and complete rib resection with the supraclavicular approach? are there downsides? thoracic outlet syndrome

Absolutely. : In fact that's the standard approach for thoracic outlet syndrome operations. There are some surgeons who may prefer a transaxillary approach, however, this has some significant limitations compared to the supraclavicular incision. Discuss with a board certified vascular surgeon or thoracic surgeon.

Yes: The approaches for thoracic outlet surgery are trans axillary, supraclavicular, and posterior. Neurosurgeons prefer the supraclavicular, which gives better visualization of the nerves, where the transaxillary allows good access to the rib. Both are effective, and the choice depends on the training and preferences.