Surgical methods for the restoration of venous flow in patients with thrombosis in the iliofemoral segment and vena cava have always been in the focus of attention. Successful elimination of venous obstruction permits to reduce severity of the disease in both acute and late phases even if it does not ensure complete recovery. At present, restoration of thrombosed main veins is achieved by open surgical thrombectomy, systemic and regional thrombolysis or transdermal mechanical thrombectomy. Surgical thrombectomy has limited indications. The use of extensive and highly traumatic open reconstructive surgery is nowadays confined to the cases when other methods prove impracticable or inefficient. Systemic therapy with thrombolytics does not give the desired results in patients with generalized occlusive thrombosis in the vena cave system. Improved methods of thrombolysis and reduction of risk of hemorrhagic complications include local administration of thrombolytic agents through a catheter directly into the thrombus or veins on the dorsal foot surface of the affected extremity. Regional thrombolytic therapy and transdermal mechanical thrombectomy are alternative methods for the treatment of acute iliofemoral and iliocaval thrombosis. Clinical studies have demonstrated their high effectiveness. At the same time, delayed results of low-traumatic endovasal interventions are not known yet since they have been quite recently introduced into the clinical practice; their cost-effectiveness and safety remain to be elucidated. Large-scale comparative studies are necessary to obtain data for the development of optimized surgical strategies for the management of acute venous thrombosis.