Deep venous thrombosis (DVT) of the lower extremity is one of the common diseases in vascular surgery. Accumulating evidences have shown that early thrombus removal is safe and effective, and can reduce the occurrence of post-thrombotic syndrome (PTS) with limb inflammatory swelling and skin ulcers as the main clinical manifestations, while improving the patients' quality of life. The methods of thrombus removal mainly include open thrombectomy, catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). The diversification of thrombus removal methods and the rapid update of equipment have provided technical reinforcement to clinicians. In addition, the rational application of the inferior vena cava retrievable filter has greatly improved the safety of thrombus removal surgery. The application of iliac vein balloon and stent after thrombus removal can avoid the recurrence of thrombus. Although there are some controversies in clinical practice and lack of high-quality and high-level research evidence, positive agreements on the necessity, efficacy and safety of thrombectomy for lower limb DVT have gradually been reached. Here, the authors present and summarize the key problems in clinical practice.