This study aims at Central venous stenosis is one of the most challenging complications in hemodialysis patients. Venous thoracic outlet syndrome is an underappreciated cause of central venous stenosis in a dialysis patient that may result in failed percutaneous intervention and loss of a functioning dialysis access. The surgical management of venous thoracic outlet syndrome is confounded by the presence of venous hypertension and soft tissue fibrosis (Fig). Limited data exist about the safety and outcome of first rib resection in hemodialysis patients, and results have been confounded by variable surgical approaches. The purpose of this study was to evaluate the safety, operative outcomes, and patency of the dialysis access after transaxillary thoracic outlet decompression. A retrospective chart review was performed from January 2008 to December 2019 of patients who underwent thoracic outlet decompression for subclavian vein stenosis with ipsilateral upper extremity hemodialysis access. Baseline characteristics and comorbidities were reviewed. Operative and postoperative courses were evaluated. Survival and patency rates were analyzed using life-table method and Kaplan-Meier curve.