Venous thoracic outlet syndrome (vTOS) is caused by compression of the subclavian vein at the costoclavicular space, which may lead to vein thrombosis. Current treatment includes thoracic outlet decompression with or without venolysis. However, given its relatively low prevalence, the existing literature is limited. Here, we report our single institution experience in the treatment of vTOS. We performed a retrospective review of all patients who underwent rib resection for vTOS at our institution from 2007 to 2022. Demographic, procedural details, perioperative and long-term outcomes were reviewed. A total of 76 patients were identified. The mean age was 36 years. Swelling was the most common symptom (93%), followed by pain (6.6%). 90% of patients had associated DVT, with 99% of these patients starting anticoagulation preoperatively. 91% of patients underwent rib resection via infraclavicular approach, 2% via paraclavicular approach (due to neurogenic component), and 7% via the transaxillary approach. Eighty-three percent of patients had endovascular intervention prior or at the time of the rib resection, with catheter-directed-thrombolysis (87%), followed by angioplasty (71%), and rheolytic thrombectomy (57%) being the most common interventions. Median time from endovascular intervention to rib resection was 14 days, with 25% at same admission. Median postoperative stay was 3 days (2-5). There was no perioperative mortality or nerve injury. Fourteen percent of patients had postoperative complications, with bleeding complications (12%) being the most common. Waiting more than 30 days between initial endovascular intervention and rib resection was not associated with decreased risk of bleeding complications. Patients were seen postoperatively at 1-month (physical exam) and 6-month (duplex) intervals or for any new or recurrent symptoms. Twenty-two percent of our overall patient population underwent reintervention, most commonly angioplasty (21%). At last follow-up, 97% of subclavian veins were patent, and 93% of patients were symptom-free. Over the last decade we have transitioned to an infraclavicular approach for isolated vTOS, with low perioperative morbidity and good patency rates. These results support the adoption of the infraclavicular approach with adjunct endovascular techniques as a safe and efficacious treatment of vTOS.