Male patient 31 ys, presented with extensive RT iliofemoral DVT on top of chronic occluded IVC, underwent first local thrombolytic technique using CDT technique using TPA 50 mg Total dose for the acute thrombus for 48 H then stenting of whole IVC to 2 cm distal to heart and extended distal to Rt femoral vein and to Lt external iliac vein guided with IVUS with Double-Barrel stenting technique for the whole IVC and iliac veins . total 6 stents Zilver vena stents 14 mm * 140 mm, 14mm * 100 mm and 14mm* 60 mm. the completion results were assessed with IVUS and venogram