Abstract A good vascular condition is fundamental for kidney transplantation. A bad arterial or venous supply may compromise graft survival. Discovery in operating theater of vascular anomalies not diagnosed by medical imaging may overwhelm operating protocol. Our cases emphasize the issue of pre operating evaluation. The cases are those of two women, aged 48 and 25 years, with chronic renal insufficiency, for whom living donor kidney transplantation was decided. During the process, a total obstruction of iliac vein was found and led to a change of technique. The dilated ovarian vein was used for the venous anastomosis while the arterial anastomosis was as usually made using the iliac artery. Post-surgical follow up was uneventful. These cases emphasize on the mandatory pre operative evaluation and the respect of guidelines in the process of kidney transplantation. They also open access to other operating strategies. The objective of this publication was to present our experience in dealing with an obstructed iliac vein and emphasize on the necessity to assess accurately vascular state in kidney transplantation .