En-bloc surgical resection remains the primary curative treatment for leiomyosarcoma (LMS) of the inferior vena cava (IVC), a rare malignant tumor in the retroperitoneum. The objective of this video is to demonstrate the surgical methods for reconstructing the IVC including primary repair, patch angioplasty, interposition tube graft replacement, and caval ligation. We present 6 case examples to show the pre- and post-operative imaging, operative techniques, and patient outcomes.