A 59 European tourist who was visiting Ireland presented with an infected ruptured 8 cm right Brachio-cephalic pseudo-aneurysm post Arterio-venous fistula. Patient had lost the power in his right arm 5 hours previously from compression on median and ulnar nerve. He has a background of HIV and Hepatitis C. Under Brachial plexus Block with a temporary tourniquet around the Axillary artery, we exposed the proximal and distal brachial artery and repaired the infected ruptured 8 cm right Brachio-cephalic pseudo-aneurysm by an interposition reversed long saphenous vein graft , end to end and mobilised part of brachio-radialis to cover the graft. The Tourist was able to fly home next day.

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