ObjectiveTo evaluate the efficacy and safety of the AcoStream device (Acotec Scientific, Beijing, China) when used in combination with other endovascular therapies in patients with deep vein thrombosis (DVT) in a lower extremity.MethodsThis single-center retrospective study included 126 consecutive patients who were treated for DVT at our institution between December 2022 and August 2024. Mechanical aspiration of thrombus using the AcoStream device was performed under local anesthesia in all cases. Residual thrombus of >30% after aspiration mechanical thrombectomy was treated by catheter-directed thrombolysis. Percutaneous balloon dilatation and stent implantation were performed in the event of residual iliac vein stenosis of >50%. We analyzed related indices during aspiration mechanical thrombectomy and evaluated the early outcome during follow-up.ResultsTechnical success (>70% resolution of thrombus) was achieved in 110 patients (87.3%). Seventy-six patients (60.3%) also underwent catheter-directed thrombolysis (mean duration 4.47 ± 2.69 days and mean urokinase dose 33.19 ± 9.58 *10,000 IU per day), and 71 (56.3%) also underwent balloon dilatation and stent implantation. The mean decrease in hemoglobin after aspiration mechanical thrombectomy was 15.20 ± 10.21 g/L. There were no major complications. The median follow-up duration was 7.87 ± 3.56 months. The primary patency rate was 92.9% (117/126). Thrombus recurred in five patients (in-stent thrombosis, n = 4; re-thrombosis, n = 1) and was treated successfully by catheter-directed thrombolysis. Post-thrombotic syndrome occurred in 7.1% of patients, including one with a venous ulcer.ConclusionsThe findings of this study indicate that use of the AcoStream device combined with other endovascular therapies is a feasible and effective treatment for DVT with a high technical success rate and satisfactory short-term results.