Venous thrombectomy as a treatment of deep venous thrombosis is discussed extremely controversial. Occasionally, however, surgical technique, goal of the therapy, indications and limitations are not really known. Indication for surgical treatment is an extensive acute deep vein thrombosis with clinical symptoms of less than 7 days. Goal of the therapy is the preservation of valve function and prevention of a postphlebitic syndrome. Further indications are an embolizing venous thrombosis, a floating thrombus and an ischemic thrombosis. In these cases the single goal of the treatment is to reduce the individual risk of the patient. The best long term results can be achieved in young patients (below 40 years of age) with no preexisting venous lesion and an acute iliofemoral thrombosis. Advantages, drawbacks and results of venous thrombectomy are discussed.