Thoracic outlet syndrome is a mechanical space problem in which the brachial plexus and/or subclavian vessels are compressed. Arterial compression is least common and almost always associated with a bony anomaly. We present a case of a 49-year-old woman with a prominent first rib which caused a subclavian artery stenosis. There are many options for subclavian artery repair through open surgery. In high-risk patients, minimal invasive techniques are favorable. To date, few case reports exist on an endovascular artery repair combined with open first rib resection. While long-term follow-up will be necessary, our preliminary results seem promising.