Chronic deep venous thrombosis (DVT) of the inferior vena cava and the iliac veins, also known as chronic iliocaval thrombosis, is a cause of significant morbidity. This may lead to limb-threatening occlusive symptoms secondary to DVT in the lower extremities, phlegmasia cerulea dolens, and postthrombotic syndrome (PTS), and may be fatal secondary to development of pulmonary embolism.[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] PTS commonly presents with leg pain, swelling, venous claudication, cutaneous hyperpigmentation, varicose veins, and venous ulcers secondary to stasis. Iliocaval recanalization and reconstruction is a minimally invasive endovascular technique used in the management of chronic iliocaval thrombosis, which involves recanalization, angioplasty, and possibly stenting, with the ultimate aim of restoring in-line venous flow throughout the iliocaval system. This technique has been shown to provide significant symptomatic relief to patients while also potentially preventing recurrent thromboembolic disease.