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Upper extremity true arterial aneurysms are rare and often present as a pulsatile mass with associated pain and paresthesia from peripheral nerve compression, and can lead to acute limb ischemia from thromboembolic sequela. History of arteriovenous dialysis access and immunosuppression after renal transplantation may contribute to the development of true aneurysms.This report describes the management of a patient with end-stage renal disease (ESRD) with multiple left upper extremity dialysis access who presented with an axillary and brachial artery aneurysm.