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We have extensive experience in the management of upper limb venous occlusion and thoracic outlet syndrome. Acute venous thrombosis is relatively common in young patients and without intervention can lead to distressing long term sequelae. We encourage urgent referral when venous thrombosis is suspected and can make a rapid diagnosis with duplex ultrasound. If this confirms the clinical suspicion, thrombolysis is commenced. This is almost always successful if performed within 2 weeks of the onset of thrombosis, and is followed by decompression of the thoracic outlet, usually by excision of the first rib.

A recent audit of the results in the Institute has demonstrated significant symptom improvement in all patients, with no patients requiring long term anticoagulation. Chronic thoracic outlet syndrome can also be treated very successfully with first rib resection, following a thorough assessment including vascular imaging and nerve conduction studies.