Congenital absence of the inferior vena cava is an uncommon venous anomaly with treatment algorithms consisting of predominately medical management. We present a case of a 36-year-old man with venous ulcers who had failed conservative treatment for recurrent venous ulcers. From a catheter directed approach, we were able to develop an extravascular retroperitoneal space and perform an iliocaval reconstruction with Wallstents. At 1-year postoperatively, his leg pain and edema had resolved, and had achieved resolution of his venous ulceration.