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A case of end-stage renal disease with bilateral iliac vein thrombosis underwent renal transplantation at our institute. Right external iliac vein (EIV) is the common site for anastomosing renal vein during renal transplantation. Patients undergoing repeated venous access for hemodialysis particularly femoral venous cannulation, have iliac vein thrombosis which we encounter during transplant workup. A 51-year-old diabetic, hypertensive female with end-stage renal disease with a history of multiple arteriovenous fistulae and bilateral femoral venous cannulation was planned for renal transplantation. On evaluation, her right common iliac vein and left EIV showed diffuse narrowing in computed tomography angiography. The renal vein was anastomosed to the proximal part of the inferior vena cava and the stump of the renal artery anastomosed to the right common iliac artery. Creatinine showed gradual decline, and the patient was discharged home on the 10th postoperative day with serum creatinine value of 1.76 mg/dl. [ABSTRACT FROM AUTHOR]