I can only speak for myself, but the research I've done and what my doctor has told me is that vascular TOS almost always has to be corrected with surgery, unlike neurogenic TOS, which may respond to physical therapy and the proper exercises. Once compression of the subclavian veins or arteries in the costoclavicular space has started, there is usually no reversal or improvement, and in fact it tends to get worse. Then you can get blood clots, aneurysms, or otherwise damaged vessels that have to be repaired. I had a doppler ultrasound of my brain and I already have microemboli (very tiny blood clots) floating around in my middle cerebral artery, so surgery for me is a must as I am a walking stroke risk. Surgery is the last thing I want, but it's what I need to stay alive, so I just have to get it over with. YUCK :-(