CONCLUSION
Despite the distinct lack of prospective, large-scale multi-centre data on the optimal management of PSS, existing literature indicates that a hybrid approach encompassing endovascular intervention and surgical decompression yields respectable results that can be further augmented by post-decompression reconstructive procedures such as PTA and venous bypass. Methods such as mechanical thrombectomy coupled with traditional CDTL are particularly promising potential approaches and established thromboembolic complications of PSS could potentially be avoided with the fitting of SVC filters. Excellent long term SV patency rates are observed with both TA and PC/IC decompression approaches in the patients included in our series. Both approaches allow excellent access for complete resection of the anterior first rib, subclavius muscle and CCL eliminating any extrinsic compression precipitating the initial thrombotic event. Overall secondary patency rate was 92% with 100% asymptomatic. Post-surgical venoplasty and venous bypass are useful procedures which aid patency rates post decompression. At present evidence is lacking as to which patients may benefit from venous reconstruction but the IC approach enables this to be performed as medial access is easily obtained for control.