Case Description: A 53 year old male, renal transplant recipient presented with a large non-pulsatile firm swelling involving almost whole left fore-arm with atrophied surrounding fore-arm muscles. He had undergone renal transplant in 2003 and had good graft function. A radio-cephalic arterio-venous fistula was created on him about two years prior to transplant surgery in 2001. Fistula was unused since then. He had noticed increase in fistula size for last 5 years, initially pulsatile but gradually pulsation was lost but size continued to increase slowly. Patient was unable to use his left fore-arm because of weight of sac and associated atrophied muscle. On examination, there was a small trophic ulcer over the sac. Ultrasound-Doppler showed large sac without any flow with thrombosed blood. After proper evaluation and taking consent, we removed the sac along with involved skin. Patient recovered well with good cosmetic outcome and presently on physiotherapy to gain maximum fore-arm function. Figure 1 shows the aneurysmal sac with wasting of forearm muscles and skin ulcer. Figure 2 show post-operative status.