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Iliac vein compression (IVC) is a common anatomic disorder affecting more than 20% of the adult population, especially young females. Most of those patients are asymptomatic. Some of them will develop symptoms in their left leg, such as swelling, pain, and heaviness. But progression to venous claudication, skin changes, and even venous ulceration is possible. Intolerance to exercise is an undervalued symptom. The most feared complication is the development of a deep venous thrombosis (DVT) and pulmonary embolism (PE). In addition to the symptomatology, the diagnosis can be confirmed using duplex ultrasound, computed tomographic (CT) scan, or magnetic resonance (MR) venography. However, for the exact measurement of the degree of stenosis and indication for stenting, intravascular ultrasound (IVUS) is the preferred tool for assessing iliac vein compression. Those patients are, especially in combination with other risk factors, at higher risk for developing DVT and PE. However, it is difficult to identify the patients who will benefit from a treatment (stenting) in terms of symptomatology and quality of life (QOL) or even in effective DVT prevention. Venous stenting is the treatment of choice and seems to be safe and effective. Poststenting antiplatelet medication is most appropriate for patients with nonthrombotic IVC, whereas postthrombotic patients should preferably be treated with oral anticoagulants. Meticulous selection of patients for treatment is necessary to avoid over-treatment.