Iliac vein compression syndrome, also known as Cockett’s syndrome, is a common cause of unexplained edema of the lower extremities. It is also the most direct cause of a portion of varicose veins and deep vein thrombosis. Anatomically, factors such as the right iliac artery riding over the left iliac vein and the anterior convexity of the 5th lumbar vertebra are the main causes of Cockett’s syndrome. The clinical manifestations are mainly edema, varicose veins, and deep vein thrombosis in the left lower extremity. Due to the deep location of the iliac veins and the interference of intestinal gas, it is difficult to diagnose by general ultrasound. Coupled with the lack of knowledge of most physicians about Cockett syndrome, it is often easily missed or misdiagnosed in clinical practice. Vascular surgeons with experience and mastery of ultrasound techniques have a distinct advantage in the diagnosis of this disease. Venography, magnetic resonance venography or CT venography are also commonly used to diagnose this disease. Treatment of iliac vein compression syndrome is mainly based on symptomatic treatment, which can be combined with Chinese and Western medicine, drugs and physical therapy. Interventional therapy is the most direct way to address iliac vein compression, and the long-term results remain to be seen, but the initial clinical results are satisfactory in terms of symptom relief, stenosis relief, and thrombosis prevention.