The aim of this paper is to describe the case of a patient successfully treated for left brachial arterial aneurysm occurring 15 years after renal transplantation and consequent 8 years after arteriovenous fistula (AVF) ligation. We describe our experience and our surgical approach. A 45-year-old man presented to our attention for a large pulsatile formation on the volatile face of the left forearm, which he reported to have enlarged in the last year. He had a history of chronic renal impairment in 2000, then AVF for dialysis was realized, and he was finally addressed to kidney transplantation in 2004. In 2011 the AVF was ligated. We observed absence of radial pulse and direct flow on the ulnar artery; a large pulsatile formation was evident along the course of the left brachial artery, associated with forearm venous dilatation. Doppler ultrasound showed fusiform aneurysm of the brachial artery with 3.5 cm diameter and longitudinal extension of 5 cm up to the brachial bifurcation. We removed the brachial aneurysm, with a venous bypass on the ulnar artery. The patient was discharged in good general condition on the second postoperative day. At 1- and 6-month follow-up he had complete recovery with graft patency, without any neurological impairment and with a good esthetic result. An open surgical repair with great saphenous vein interposition seems to be the best choice in terms of patency and perioperative morbidity.