tion of both legs and dyspnea on exertion. His pain-free walking distance was below 200 m. In 1979, a diagnosis of IgA-nephropathy was established following an open leftsided renal biopsy. His kidney disease was progressive and from 1984 until 1993 the patient underwent chronic hemodialysis. In 1993, he received a renal allograft into the right iliac fossa. His current serum creatinine is 1.28 mg/dl. Upon presentation pulses were palpable in both ankles. Blood pressure was 130/80 mmHg. The ankle–brachial index of the right and left leg were 0.80 and 0.85, respectively. Owing to his symptoms magnetic resonance angiography of the aorta and both legs was performed. Angiography revealed a large arteriovenous fistula of the left kidney (solid arrow) with rapid filling of the inferior vena cava (Panel A). In addition, a stenosis of the right external iliac artery proximal to the renal transplant was noted (dashed arrow, Panel A). The patient underwent coiling of the renal arteriovenous fistula and balloon angioplasty of the stenosis. A follow-up magnetic resonance angiogram 3 months later revealed complete closure of the fistula and no Vascular Medicine 15(5) 433–434 © The Author(s) 2010 Reprints and permission: sagepub. co.uk/journalsPermissions.nav DOI: 10.1177/1358863X10376000 http://vmj.sagepub.com