Controversies in VTOS: Is costoclavicular junction decompression always needed in VTOS?

Abstract

Extrinsic compression of the subclavian vein as it traverses the costoclavicular space is postulated as the cause of venous thoracic outlet syndrome, and many believe that costoclavicular space decompression - by first rib resection or by claviculectomy - is required to treat this condition as well as to prevent its recurrence. Alternative therapeutic approaches include bypass of the obstructed vein, usually to (or utilizing) the ipsilateral internal jugular vein, or, alternatively, withholding operative intervention and instead allowing axillosubclavian vein thrombolysis and recanalization and venous collateralization to decompress the congested ipsilateral upper extremity.