65-year-old male, referred from Nephrology to the Vascular Surgery Department for presenting a voluminous pulsatile mass on the left forearm, of several years' evolution, with accelerated and progressive growth in recent months. Personal history of arterial hypertension, dyslipidaemia, left radiocephalic fistula for haemodialysis performed twenty years earlier due to terminal chronic renal failure, and six years after being transplanted, the fistula was ligated.
On physical examination, on the anterior aspect of the left forearm, there was a huge pulsating tumour, with no murmur or thrill. His hands were well perfused, with radial and ulnar pulses present.

Firstly, an echo-Doppler was performed, which showed intense flow within the tumour, without being able to define whether it was an aneurysm or a pseudoaneurysm, an axial computed tomography angiography (angio-CT) was therefore requested, showing an ectatic and elongated humeral artery, and in the radial region an aneurysm or pseudoaneurysm of 62 millimetres in diameter, with the ulnar and interosseous arteries permeable and the distal radial artery obstructed.
With the diagnostic suspicion of aneurysm or pseudoaneurysm of the radial artery secondary to radiocephalic AVF ligated in a transplant patient, surgical treatment was indicated.
Through incisions at the level of the flexure of the arm and distally at the radial level, the humeral, radial and ulnar artery was dissected and controlled, revealing a large true aneurysm along the entire course of the radial artery. Complete resection of the aneurysm was performed, ligating the radial artery proximally and distally, as it was found to be chronically thrombosed and the vascularisation of the hand was ensured by the ulnar and interosseous arteries.

The postoperative period was uneventful; on discharge he had humeral and ulnar pulses and good perfusion of the hand. Pathological anatomy confirmed that it was a true radial artery aneurysm. One year after treatment, the patient is asymptomatic and without complications.

