The role of endovascular therapy in venous thoracic outlet syndrome (VTOS) is critical but complex, particularly with regard to the role of stent placement. The borders of the venous thoracic outlet are rigid, potentially limiting the utility of stents in the pre-surgical setting and creating significant long-term problems if the thoracic outlet is not decompressed. Following decompression, there is evidence that most patients can achieve long term patency with angioplasty alone, but in a certain subsets of patients, post-decompression stenting (ideally with long-term follow up) may provide lasting results.