This video details the presentation of a patient with infrarenal and retrohepatic inferior vena cava neoplastic thrombosis secondary to renal cancer not amenable to thrombectomy due to infiltration of the caval wall. The patient underwent an inferior cavectomy from hepatic veins to iliac bifuraction and replacement with large ex-panded polytetrofluorethylene graft (ePTFE) 20 mm. in diameter and 28 cm. in length. A groin arteriovenous fistula was created between the superficial femoral and saphenous.