Background and Aims Currently, the indications for iliac vein compression (IVC) stent implantation remain unclear. In addition, for patients with combined IVC and lower extremity varicose veins, some scholars believe that if there is low pressure difference across the narrow segment of the iliac vein (<2 mmHg), simply treating lower extremity varicose veins can effectively improve lower limb symptoms. Therefore, this study was performed to analyze the short-term clinical outcomes of performing radiofrequency closure surgery for lower extremity varicose veins alone in such patients.Methods The data of patients who underwent endovenous radiofrequency ablation for lower extremity varicose veins in Beijing Shijitan Hospital of Capital Medical University from June 2020 to June 2022 were retrospectively analyzed. According to iliac vein ultrasound, CTV, and lower extremity venography examinations, patients with IVC and collateral circulation formation with a pressure difference <2 mmHg (IVC + varicose veins group) were selected. Propensity score matching was then employed at a 1:3 ratio to match patients with lower extremity varicose veins only (varicose veins group). The primary endpoints were the occlusion rates of the saphenous vein trunk at 1 week and 3, 6, and 12 months after operation. Secondary endpoints included venous clinical severity score (VCSS) and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) scores at 6 and 12 months after operation.Results A total of 29 patients were identified in the IVC + varicose veins group, matched with 87 patients in the varicose veins group. There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). After the first postoperative ultrasound examination, the occlusion rates of the saphenous vein trunk were 100.0% in both groups. At 3, 6, and 12 months of follow-up, the occlusion rates in the varicose veins group vs. IVC + varicose veins group were 100.0% vs. 100.0%, 97.7% vs. 100.0%, and 98.8% vs. 100.0%, respectively, with no statistically significant differences (all P>0.05). VCSS and CIVIQ-20 scores significantly decreased in both groups compared to preoperative values (all P<0.05), but there were no statistically significant differences between the two groups (all P>0.05). Both groups had no severe adverse events such as deep vein thrombosis, and the overall incidence rates of complications after operation showed no statistically significant difference between the varicose veins group and the IVC + varicose veins group (20.7% vs. 24.1%, P=0.69).Conclusion For patients with combined IVC and lower extremity varicose veins showing low pressure difference across the narrow segment of the iliac vein, endovenous radiofrequency ablation as a minimally invasive treatment can achieve favorable short-term outcomes. However, further examination is needed to assess its long-term effectiveness.