How to Avoid Unnecessary Stenting in NIVL Cases.

This Vein and Lymphatic University Grand Rounds session features an expert clinical discussion on non‑thrombotic iliac vein lesions (NIVL/May–Thurner syndrome) and the appropriate use of iliac vein stenting. The session is moderated by Dr. Anil Hingorani, United States, and led by Professor Mark Whiteley, United Kingdom, Founder of The Whiteley Clinic. Invited discussants include Dr. Mikel Sadek, United States, Dr. Steven Abramowitz, United States and Dr. Michael Lichtenberg, United Kingdom. Through a detailed case presentation and multidisciplinary panel discussion, the faculty examine the risks of over‑reliance on cross‑sectional imaging, the importance of functional venous assessment, and long‑term considerations of venous stenting—particularly in younger patients. The discussion integrates expert opinion, physiologic testing, and real‑world clinical experience. Key learning points: • Iliac vein compression on imaging does not equate to clinically significant outflow obstruction. • Functional testing and symptom correlation are essential before considering NIVL stenting. • Superficial venous reflux should be treated first when it explains clinical findings. • Venous stents carry lifelong risks, requiring careful patient selection. • Borderline cases demand cautious, stepwise decision‑making rather than first‑line stenting. This session offers practical guidance for clinicians managing complex venous disease in contemporary practice.