Objective To evaluate the efficacy and safety of ultrasound in percutaneous mechanical thrombectomy (PMT)of acute deep venous thrombosis of lower extremity(DVT). Methods 132 patients with acute DVT were divided into two groups: 82 cases in ultrasound group and 50 cases in venography group. Venous Patency, limb circumference difference, blood biochemical indicators, operation time, complications and follow-up were evaluated and compared between two groups after PMT combined with catheter-directed thrombolysis treatment. Results The venous patency rates of ultrasound group and venography group were 82% and 77.7%, respectively. There were no significant difference between two groups in venous patency after PMT treatment (All P＞0.05). Operation time in ultrasound group(1.08±0.32h) was less than that in venography group(2.36±0.25h)(P=0.000).The incidence of complications in ultrasound group (12.2%) was lower than that in venography group (26%)(P=0.016). The content of Hemoglobin in ultrasound group(125.66±15.48g/L) was higher than that in venography group (91.53±11.73g/L)(P=0.004). There were no significant differences in limb circumference difference, d-dimer concentration, Villalta score and VEINES-QOL score after operation (All P＞0.05) . Conclusion Ultrasound is safe and effective in PMT treatment of acute DVT. Compared with the traditional venography mode, it has the advantages of no radiation, short operation time and low complications.