Chronic, post-thrombotic iliofemoral (IF) and inferior vena caval (IVC) obstruction is associated with debiliting morbidity. While balloon venoplasty and stenting are often successful for isolated iliac vein lesions, when performed in the presence of a diseased/occluded common femoral vein (CFV), failure is common. A hybrid operative procedure which includes an open surgical CFV endovenectomy followed by endoluminal recanalization or bypass of the obstructed iliofemoral-vena caval segments has been developed and modified.