In the case of arterial TOS it is largely agreed that surgery is pretty much the only option. From what I hear of your wife's condition- it sounds like she really needs surgery and soon for her quality of life and well-being. But I am not a doctor.

Anyway, I had arterial TOS and also couldn't do all the things you listed. It was terrible. I had both first ribs removed about 3 months ago and I saw an improvement immediately though not all of my symptoms are gone and recovery can be a bit rough. If I could reverse time though, I would absolutely get the surgery again.

No matter what, though, your wife will probably not be able to carry heavy loaded backpacks. There will always be some amount of restriction because you don't want scar tissue to grow in the area and cause TOS all over again. She will need to know her limitations and adjust to them. It will be better than where she's at now though.

I wish her the best of luck!!