Dr. Ahn has you do fluoroscopic angiogram/angioplasty before he recommends a surgical plan. He no longer uses scalene blocks or doppler ultrasound for diagnostics and indications for surgery. His logic is that the neurovascular bundle follows the same path so even though you don't have vascular symptoms he will find vascular constriction. He will then blow up the balloon catheter (angioplasty) to open up the constriction which will open up the path for the nerves as well. He says that this should give immediate relief for neurogenic TOS and let him know what surgical approach to take. His peers do not currently share his enthusiasm over this approach as it is an invasive procedure which may not tell you anything that other non-invasive tests do. I believe he is preparing a study and will be presenting at some vascular conference later this year. I ended up having MRI/MRA instead which Dr. Angle believes will show the same results minus the balloon angioplasty. Read through this thread's history to see more opinions regarding Ahn.

Dr. Angle studied at UCLA under Gelabert and Ahn then practiced there. He went on to be the head of vascular surgery at UCSD. He is now in private practice at St. Joseph's Mission Hospital in Mission Viejo. Since I have chosen him as my surgeon, of course I recommend you consult him for an opinion. I spoke to my own neurosurgeon, and he believes the vascular guys are best equipped to treat TOS and I agree based on my own research.

Since you believe you only have neurogenic symptoms, did you get the MRN (Neurography) study developed by Dr. Filler? If so, what did it show? I believe UCSD can perform these now as well. I once thought my symptoms were only neurogenic until my condition worsened and Drs. Gelabert, Ahn, and Angle honed in on the vascular signs. Eventually, I was able to psychologically accept that letting go of the rib was necessary.