Did you get your TOS from repetitive stress? Poor posture? Do you know? I feel for you, it's a tough call.
http://my.clevelandclinic.org/disord..._syndrome.aspx
This is a good link, and there are others:
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Although only 10 to 20 percent of patients with TOS need surgical treatment, most patients with venous or arterial TOS will need surgical treatment. Surgery for venous and arterial TOS is very effective. Among patients with venous TOS, elective surgery corrects symptoms in 90 to 95 percent of cases; elective surgery resolves symptoms in more than 95 percent of patients with arterial TOS.
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** What they don't tell you is that the scar tissue most often results in worse neurological symptoms. Many people wind up in MORE neurological pain after the surgery. I have consulted with a vascular surgeon who says his success rate is something like 95% -- It seems that almost any surgeon will tell you that you'll be fine, but I have yet to read of someone who had Neurological decompression that came out fine long term.
There are several links on the "success" of surgery, and there are personal accounts of those who have had it. It seems like those who have / got TOS from a cervical rib or a traumatic event (like a car accident) fare better than those who have it from microtrauma (repetitive stress).
Another good link:
http://www.ecentral.com/members/rsanders/
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The improvement rate with surgery varies with the cause of the TOS. Prior to 2005, auto injuries had a success rate of about 80% while repetitive stress at work has a success rate of 65-70%. Since adding pectoralis minor release to thoracic outlet operations and wrapping nerves during surgery with a plastic film, the success rate has increased to over 85% in both groups.
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From my perspective, without vascular involvement - surgery is a tough sell. When I "read" 70% success rate, I'd be more thinking more like 70% failure rate - based on what I read everywhere.
I feel for you, but if it's any consolation I'm in the same boat. I meet with a vascular specialist again in a week to see how much (if any) vascular involvement I have. And as you've experienced, who knows if that will remain for the future. I could have neurological issues one day, and the next month vascular. Seems to come on out of nowhere.
Were you doing conservative treatment to open up your thoracic triangle regularly BEFORE the vascular issues?