Massive DVT from the proximal IVC to the pedal vein: Our approach using aspiration mechanical thrombectomy and open surgery thrombectomy.

Deep venous thrombosis might present in an acute condition requiring early thrombus removal. Several endovascular and surgical approaches are available with a short treatment time and minimal complications compared to pharmacotherapies. However, due to a lack of evidence, these are not the first treatment choice for deep vein thrombosis. Our case report showed a successful multimodality treatment for an acute-on-chronic massive deep vein thrombosis from the inferior vena cava to the pedal vein. A 47-year-old with chief complaints of cold, significant swelling, and severe pain in her left leg was diagnosed with deep vein thrombosis through Doppler ultrasound and contrast-enhanced computed tomography. The patient received aspiration mechanical thrombectomy with the "kissing catheter" technique, adjunctive stent, percutaneous transluminal angioplasty, and open surgical thrombectomy by Fogarty catheter without recurrence and complication.