Iliac vein compression syndrome is the phenomenon of nonthrombotic ili
ac vein obstruction caused by compression of left iliac vein between t
he right iliac artery and fifth lumbar vertebra. Affected patients usu
ally present with unilateral leg edema. The condition is most often se
en in women, in whom it may also be a cause of vulvar varicosities. Pr
esented here is a case of idiopathic iliac vein obstruction associated
with an ipsilateral varicocele in a young man. This varicocele was ca
used by multiple collateral venous channels and was resistant to surgi
cal high ligation. This case illustrates an unusual cause of varicocel
e formation and an anatomic reason for failure of standard surgical th
erapy.