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deviation [SD], 11.8 years); 59.7% were female. The majority (80.8%) had neurogenic TOS with venous and/or arterial components based on clinical presentation and/or radiologic evidence; 16.5% had isolated venous TOS; and 2.7% had isolated arterial TOS. Most common symptoms were paresthesia (78.1%), pain (66.9%), and weakness (55.4%); a prior history of trauma was present in 19.6%. Paget-Schrotter Syndrome was the presentation in 60/260 (23.8%) e one-third of these were treated with subclavian vein thrombolysis, with a median time from thrombolysis to decompression being 119 (interquartile range [IQR], 98-270) days. Six (2.3%) presented with acute or chronic limb-threatening ischemia. Three (1.2%) underwent redo-decompression in the context of prior incomplete decompression and persistent symptoms. Surgical approach was supraclavicular in 99.2% and paraclavicular for arterial reconstruction in 0.8%. Adjunctive procedures included accessory cervical rib resection (12.3%); long C7 resection (2.7%); subclavian artery reconstruction (1.5%); and arterial thrombectomy (0.4%). Mean hospital length of stay was 3.4 days (SD, 2.8 days). Most common 90-day complications were pleural effusion requiring thoracostomy tube (5.0%), pneumonia (3.8%), chyle leak (3.1%), transient long-thoracic nerve neuropraxia requiring intensive physiotherapy (1.2%), and hemothorax requiring re-intervention or thoracostomy tube (1.2%) (Table ). There were no perioperative mortalities. Rates of 90-day readmission and emergency room visit were 3.9% and 8.5%, respectively. After a mean follow-up of 202 days (SD, 273 days), 93.3% of patients reported improvement or resolution of TOS symptoms.Conclusions: Supraclavicular decompression in patients with neurogenic, venous, and/or arterial TOS can be performed safely with low perioperative event rates. Careful patient selection and a comprehensive approach to decompression are keys to achieving optimal outcomes.