The aim of this double blind randomized controlled study is to evaluate catheter directed thrombolysis for acute DVT vs. the traditional systemic anti-coagulation therapy. 30 patients with acute DVT, 18 females and 12 males, ages ranged between 27 and 74 years were included. Diagnosis was achieved after clinical examination and duplex study of the venous system. The 30 patients were randomly distributed into 2 equal groups A& B. Group-A patients were managed by catheter directed thrombolysis via a posterior tibial vein surgical approach. Group-B patients (control group) were managed by the traditional systemic anticoagulation therapy. No major complication i.e. pulmonary embolism or major bleeding was encountered. However in group-A, minor bleeding at the access wound occurred in 46.2%, mild wound infection in 38.5% and mild allergic reaction to streptokinase in 23% of the patients. Early follow up results were as follows; complete re-canalization 38.4% in group-A vs. 6.7% in group-B, partial re-canalization 46.2% in group-A vs. 60% in group-B, and poor re-canalization 15.4% in group-A vs. 33.3% in group-B. In group-A the overall continued one-year patency rate was 50%. Lysis grade in the early follow up was predictive of the one-year patency rate as follows; 100% in patients with complete re-canalization, 33.3% in patients with partial re-canalization and 0% in patients with poor re-canalization. In group-B the overall continued one-year patency rate was 0%.