Background and Aims Early thrombus removal and debulking for deep vein thrombosis (DVT) of the lower extremities can restore venous patency and relieve symptoms. At present, AngioJet is the most commonly used venous thrombus removal system in China, while Aspirex is infrequently used. Therefore, this study was conducted to investigate the efficacy and safety of percutaneous mechanical thrombectomy (PMT) using Straub Aspirex in the treatment of patients with acute lower extremity DVT after trauma.Methods The clinical data of 54 patients with DVT after trauma treated in the Department of Vascular Surgery of Beijing Jishuitan Hospital from May 2016 to August 2020 were retrospectively analyzed. All patients underwent inferior vena cava retrievable filter implantation, with Dneali in 35 cases (64.8%), Celect in 3 cases (5.6%), Cordis in 14 cases (25.9%), and Octoparms and Tempofilter II in one case (1.9%) each. The iliofmoral and inferior vena cava vein thrombosis in all patients were identified by color ultrasound examination or venography after surgery and fixation for trauma. Among them, 22 cases (40.7%) had iliofemoral vein thrombosis, 4 cases (7.4%) had iliac and inferior vena cava vein thrombosis, 11 cases (20.4%) had inferior vena cava thrombosis, and 17 patients (31.5%) had iliofemoral and inferior vena cava vein thrombosis. All patients underwent Straub Aspirex PMT under local anesthesia via femoral or popliteal vein approach, combined with manual aspiration thrombectomy (MAT), catheter-directed thrombolysis (CDT), balloon dilation, and stent implantation. The technical success rate, immediate clinical success rate (symptom remission rate), perioperative bleeding rate and filter removal rate were calculated. One-year follow-up was performed, and the target venous patency rate and the incidence of post-thrombotic syndrome (PTS) were evaluated by ultrasound.Results Of the 54 patients, 3 cases (5.6%) underwent mechanical thrombosis alone, 17 cases (31.5%) underwent manual aspiration thrombectomy, 3 cases (5.6%) underwent CDT, 18 cases (33.3%) underwent CDT and MAT, 12 cases (22.2%) underwent MAT and iliac vein balloon dilation, and 1 case (1.9%) underwent MAT and stent implantation. Both technical success rate and immediate clinical success rate were 100%. Grade III thrombus clearance was achieved in 12 patients (22.2%), grade II clearance was obtained in 33 patients (61.1%), and 9 patients (16.7%) had grade I clearance. The success rate of thrombus removal was 83.3%. In the perioperative period, cerebral hemorrhage occurred in one patient (1.9%), and hematoma absorption was seen on head CT examination without sequelae 2 weeks after discontinuation of thrombolysis and anticoagulation, epistaxis and puncture point hematoma occurred in 2 patients (3.7%), which were relieved after compression, and there were no complications such as symptomatic pulmonary embolism and death occurred. The filter retention time was (61.4±84.8) d, and filter retrieval was attempted in 51 patients (94.4%), being successful in all of them. There was no recurrence of thrombosis and other complications after operation. At one year after operation, the incidence of PTS was 33.3%, and the target venous patency rate was 75.9%.Conclusion For patients with acute iliofemoral and inferior vena cava DVT after trauma, PMT using Straub Aspirex has demonstrable efficacy with reliable safety, and the combination of manual aspiration thrombectomy, CDT and iliac venoplasty can improve the venous patency rate.