Dr. Aghayev has developed a unique, posterior approach which allows complete removal of the first rib and decompression of all involved nerves and vessels. It is the most effective surgical technique for treating thoracic outlet syndrome. 

The surgical procedure is performed from the back with approximately 5 cm (2 inch) incision. The 1st rib and accessory cervical rib (if present) are resected first, without significant exposure and manipulation of the brachial plexus nerves. Bone removal provides decompression of the subclavian artery and vein and increases space for further manipulation. Then the brachial plexus is freed from all fibrotic, muscular and vascular bands and decompressed. 

There are several advantages of posterior approach over others. 

1. The first and accessory rib removal is easy and safe since there are no overlaying and overpassing nerves and vessels. 

2. The brachial plexus is closest to the skin posteriorly allowing the surgeon to work in a shallow area. Additionally, subclavian vessels are deeper to brachial plexus and not intefering with manipulation. Therefore, the decompression is easy, safe and effective. 

3. The most important advantage of PURE technique is the absence of recurrence due to total resection of the accessory and first ribs. 

4. PURE technique provedes very high level of safety compared to other approaches due to minimal vascular and nerve manipulation.