Purpose: To present a new endovascular technique for treating acute large thrombus burden in the iliocaval venous system. Technique: This method is demonstrated in a 62-year-old man with end-stage renal disease on hemodialysis who had a nonfunctioning right femoral dialysis catheter that was placed 3 month earlier. After catheter removal, venography demonstrated significant thrombus in the inferior vena cava (IVC) and both iliac veins. The patient was treated successfully using two simultaneously operating Trellis-8 thrombolysis catheters placed side-by-side in the IVC and both iliac veins in a "kissing" configuration. Conclusion: This technique was able to effectively debulk acute large thrombus burden in the iliocaval system in a single session and preserve the patient's available hemodialysis access. The technique has the potential to minimize morbidity, duration of hospital stay, and overall cost of treatment. © 2011 by the International Society of Endovascular Specialists.