Early UK Experience with Aspiration Thrombectomy Followed by Urgent Surgical Decompression for Acute Venous Thoracic Outlet Syndrome

Introduction: Venous thoracic outlet syndrome (vTOS) results from compression of the axillary or subclavian vein and may present with acute upper limb deep vein thrombosis. Catheter directed thrombolysis followed by decompression is widely performed but carries bleeding risk and may delay definitive surgery. Mechanical thrombectomy offers a lysis free alternative. This study aimed to assess early outcomes of mechanical thrombectomy followed by urgent surgical decompression in vTOS patients. Method: This paper reports a retrospective single centre case series of patients with vTOS treated with Penumbra Indigo (Penumbra Inc., California, USA) mechanical thrombectomy followed by urgent surgical decompression between January 2025 and February 2026. Results: Four patients (ages 17, 27, 42, and 35 years) underwent successful thrombectomy between one and 21 days after the deep vein thrombosis but within one and six days from referral, followed by first rib decompression within zero to four days. All patients achieved full resolution of symptoms and technical success, evident on follow up venograms, with restoration of central venous flow and no major complications. Conclusion: Early experience suggests that mechanical thrombectomy followed by urgent decompression is feasible and safe in selected patients with acute vTOS. Larger studies with longer follow up are required.