Objective: To investigate the clinical efficacy of endovascular therapy for iliac vein compression syndrome (IVCS). Methods: The clinical data of 244 patients with IVCS undergoing endovascular treatment from January 2014 to December 2015 were retrospectively analyzed. Results: No surgical death occurred in the entire group, and endovascular treatment was abandoned in one case due to complete occlusion of the left iliac vein, so the technical success rate was 99.6% (243/244). Of the 243 patients, 94 cases underwent balloon dilatation alone, and 149 cases received balloon dilatation with stent implantation; 175 cases with varicose veins of lower limbs were subjected to a second stage operation. Two hundred and twenty-four patients were followed up for 3 to 27 months, during which time, no relapse of varicose veins was observed; the lower limb swelling was alleviated with varying degrees in all patients, and the treatment effective rate was 100%; hyperpigmentation was reduced with varying degrees in 63 patients, and alleviation or healing was seen in 30 patients with venous ulcer. The rate of complete relief of the left lower limb swelling, complete ulcer healing and restenosis or thrombosis formation in the iliac vein showed no significant difference on postoperative 6 months between patients undergoing balloon dilatation alone and balloon dilatation plus stent implantation (96.0% vs. 99.0%, 84.6% vs. 100.0% and 5.3% vs. 2.0%, all P>0.05), but were significantly better in the latter than the former on postoperative 12 and 24 months (70.0% vs. 96.0%, 61.5% vs. 94.1% and 12.8% vs. 2.0%; 60.9% vs. 94.8%, 53.8% vs. 94.1% and 23.5% vs. 2.1%, all P<0.05). Conclusion: In treatment of IVCS, endovascular therapy offers favorable short- and mid-term efficacy and the mid-term efficacy of balloon dilatation plus stenting is better than that of balloon dilatation alone. Selection of the suitable type, diameter and length of stents, accurate and appropriate stent placement, and regular and sufficient anticoagulant therapy have great importance for better long-term results.