Chronic pelvic pain due to left common iliac compression. The patient has no lower extremity symptoms. Transabdominal ultrasound examination (not shown) demonstrates >50% compression of the left common iliac vein, retrograde flow in the left internal iliac vein, and periuterine varices. Intravascular ultrasound (IVUS) (not shown) demonstrates 70% cross-sectional area reduction of the left common iliac vein at the crossing of the right common iliac artery. Antegrade venography demonstrates flattening of the left common iliac vein with contrast attenuation at the arterial crossing (black arrow) and left internal iliac reflux (white arrow). Associated pelvic varices are better seen on delayed imaging (not shown). The Symptoms-Varices-Pathophysiology (SVP) classification is S2V2PLCIV,O,NT; LIIV,R,NT.