Hi to you all, good people

I am at the point where I need to make a decision for or against the bilateral surgery(s) for venous TOS.

Here is my story.

I never had any problems with my arms, shoulders or neck - no pain, no discomfort, nothing. Last year I was exercising more than normal - particularly I was running quite frequently - pretty much every day for 1h.

After a few months of running I start to experience some shoulder pain but nothing serious. Then all of the sudden one night I woke up with swollen arm and went to A&E. I was diagnosed with subclavian vein DVT. I was put on warfarin (heparin for a few days) and sent home.

For a next few months I did a bunch of blood test and they all came normal. In the meantime my arm gone back to normal - both in appearance and colour and I don't have any pain or discomfort.

Finally I did MRI scan of my neck and shoulder area. On scan report, they said they can see significant vein narrowing in stress position (arms up). No cervical rib, no fibrous band. Arteries are fine, no compression. A few more months have passed and I finally saw a vascular surgeon.

He told me that according to MRI scan I have a significant compression of veins on both sides between first rib and clavicle. He offered me a surgery. The main reason for surgery is the fact I got DVT and they can see narrowing on both sides (although, radiologist wasn't sure if the narrowing is significant enough to cause toracic outlet syndrome). He said they would remove the part of the first rib and muscle to decompress the passage. Although he recommends the surgery, he said the decision is on me. Surgery in itself brings some risks.

I am still taking anti-coagulant (not warfarin, but xalerto). Much more convenient than warfarin.

I have no idea how to make my decision. I definitely don't want to be restricted all my life for not doing any physical activity although I can live without weight lifting. I am 27 healthy male.

I ask them how many surgeries of this type they do and he said they do up to 10 per year as it is quite uncommon problem (I live in London, UK). Is that enough?

Can anyone please give me any advise on this? At the moment I have zero issues - no pain, no discomfort, nothing. I don't mind taking anti-coagulants as I have no restriction in diet and I don't need to be tested. But I don't want to risk to get another clot which might cause much more problems.

Sorry for making it a long story. I suppose I am a bit lost. I wish you all the best to all of you and many thanks in advance.