True brachial artery aneurysms (BAAs) are uncommon peripheral vessel aneurysms that typically occur in the setting of injury. While its relationship with trauma and infectious etiologies are well defined, the association between arteriovenous fistulas (AVFs) and BAA is less well understood. We present a case of a giant true BAA that presented several years post-AVF ligation. A review of BAA, its association with AVF, and its management follows.