|A 57 year-old male patient was transferred from local hospital. He had a diabetes mellitus for 15 years on medication and was a current smoker with 60 PYRs. He presented with severe intermittent, cramping leg pain on the left side with swelling. Doppler ultrasound examination for the lower extremity was performed, only demonstrating no visible thrombi. Lower extremity CT angiogram was performed then, which revealed a bit increased muscle volume on the left side compared to the right side, without any evidence of venous thrombosis. Because the patient`s symptom was slightly relieved after oral anticoagulation with warfarin, the patient was discharged and treated medically. After 3 months however, the patient`s symptom got worsen in spite of medical treatment. So, the patient was admissioned for venous angiography. On left sheath angiogram, there was a total occlusion of left iliac artery with a venous collaterals from stump to the contralateral right iliac vein. So, we decided to open it up. After successful glidewire passage to IVC, right common femoral vein was punctured. After that, in order to prevent thromboembolism during intervention, IVC filter was positioned. Then, balloon predilation was performed. However, stump distal portion was a bit opened and the vessel was not recanalized. So, in order to aspirate the possible thrombi inside the occluded lesion, 6Fr multipurpose catheter was advanced to the iliac bifurcation and pulled back with negative pressure with syringe, which revealed only few red thrombi. On follow-up sheath angiogram, there was a faint distal flow toward IVC. So, we decided to put a stent. Finally, distal stump was identified and the catheter tip was positioned as a marker. Then, Wallstent was deployed successfully at the occlusion site. Final angiogram revealed good flow from left iliac vein to IVC. After the procedure, the thickness of left thigh was gradually reduced over time. Three days later, IVC filter was removed, which revealed a little thrombi inside the filter. The patient was discharged with much symptomatic improvement and doing well until latest OPD follow-up visits.