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Treatment pathways and outcomes recorded as freedom from symptoms and venous patency were analyzed. Thirty-five patients were identified with vTOS. Ninety-one percent of patients had patent veins at discharge from clinical follow-up and were symptom-free at a median of 44 months. Patients treated within seven days of symptoms (94.7 versus 85.7, P = 0.060), with catheter-directed thrombolysis (94 versus 87.5% P = 0.702) and excision of first rib in less than 30 days (100 versus 85.7%, P = 0.002), had improved symptom-free rates. In conclusion, early referral, immediate catheter-directed thrombolysis, perioperative balloon venoplasty and early thoracic outlet decompression may provide a suitable model for improving outcomes in vTOS. <\/jats:p>","DOI":"10.1258\/vasc.2011.oa0325","type":"journal-article","created":{"date-parts":[[2012,6,19]],"date-time":"2012-06-19T17:53:48Z","timestamp":1340128428000},"page":"138-144","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Modernizing the treatment of venous thoracic outlet syndrome"],"prefix":"10.1177","volume":"20","author":[{"given":"Richard F","family":"Bamford","sequence":"first","affiliation":[{"name":"St George's Vascular Institute, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J E","family":"Holt","sequence":"additional","affiliation":[{"name":"St George's Vascular Institute, London, 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