Purpose: The aim of this study is to evaluate the role of percutaneous aspiration thrombectomy (AT) for the initial endovascular management of deep vein thrombosis (DVT) and to analyze the success rate and complications according to the symptom duration. Methods: Forty patients who were diagnosed with DVT from June 2004 to January 2009 were retrospectively examined. The patients were divided into 3 groups; group I, those with symptoms lasting ≤14 days; group II, those with symptoms lasting 15∼28 days; group III, those with symptom lasting >28 days. All of the patients were initially treated with percutaneous AT using the Pullback technique. The incomplete elimination of large and hard thrombus was managed with overnight catheter directed thrombolysis (CDT) and additional AT. Successful recanalization was defined as successful restoration of antegrade flow in the treated veins with elimination of any underlying obstructive lesion. Results: Initial successful recanalization with only AT was achieved in 24 (60%) patients. CDT was required in 16 (40%) patients who had remaining thrombus. Final successful recanalization was achieved in 37 (92.5%) patients. There were no significant differences in the final recanalization rate, the mean number of ATs and the duration of the procedure among groups I, II and III. There was one case (group I) of procedure-related complication, which was the occurrence of a retroperitoneal hematoma after overnight CDT. Conclusion: Percutaneous AT may be an initial therapeutic option for DVT, and it minimizes the risk of hemorrhagic complications. It is an effective treatment method for subacute and chronic DVT, as well as acute DVT.