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.