Objective — to analyze the effectiveness of active surgical approach in patients with inferior vena cava system thromboses and their embolic consequences. Material and methods. The study included 569 patients with acute thrombosis in IVC system. Thrombosis with high risk of embolism was in 297 (52%) patients, low risk — in 272 (48%) patients. Surgical approach was applied for thrombosis with high risk of embolism (open surgery, inferior vena cava filters implantation). Mortality, morbidity and incidence of recurrent venous thromboembolic complications were analyzed. Symptoms of chronic venous diseases and recanalization of thrombotic veins were assessed in 1 year and later. Results. Overall mortality rate was 1.7% (5 patients), morbidity rate — 12% (44 patients). Mortality after open procedures for massive embolic complications was 10% (3 patients), incidence of complications — 32%. The best mid- and long-term results were obtained in patients who underwent open thrombectomy followed by great vein plication without IVC filter implantation compared with patients who underwent CF implantation or thrombectomy with CF implantation. Conclusion. Active surgical approach with thrombectomy from superficial and deep veins of the lower extremities and pelvis, IVC is characterized by the same effectiveness and safety in early postoperative period as endovascular prevention of pulmonary embolism. Moreover, long-term results of thrombectomy are significantly better compared to IVC filter implantation. Open thrombectomy from pulmonary artery and right cardiac chambers for massive thromboembolic complications is characterized by low mortality rate.