Dr. Thompson has a good reputation as a TOS surgeon. Just my opinion, but I don't think venous TOS is anything to mess around with. I would proceed with the vascular surgery (after getting additional opinions, of course - check the Dr. and PT sticky at the top of the forum). My reading of your MRA indicates severe stenosis/narrowing when your arms are raised, which spells trouble. It's not like PT or meds are going to resolve much of anything… more importantly, I would not wait until more blood clots appear. One of the wrong size or in the wrong place can do so much damage (to your arms, for example). Unfortunately, it does appear that you have VTOS bilaterally, not just on one side. So you might be looking at 2 separate surgeries if you decide to go that route. It's a mechanical problem which can be repaired surgically, on a proactive basis. Also, you have a much, much higher chance of a good recovery than those of us who have primarily neurogenic TOS, so don't be put off by the horror stories you may see here. Use the forum search function to find posts by others with VTOS who have had the surgery. Might also be helpful in formulating questions and concerns for you to go over with your docs. You can also ask permission to contact 2 or 3 of Dr. T's former VTOS patients, to get their experiences first hand. A lot of patients are more than willing to do this. Just my 2 cents' worth! Good luck to you whatever you decide to do.