Pseudoaneurysm of inferior epigastric artery (IEA) is a very rare clinical entity. We reported a case of combined kidney transplant and pseudoaneurysmectomy in a young HBV-HCV-HIV recipient. This case emphasizes the possibility of planning a safe and correct surgical treatment and the best timing to treat IEA pseudoaneurysm. An exhaustive preoperative radiological study in all patients candidate to kidney transplant could identify the possible aortoiliac disease both stenotic or dilatative even if it is rare and helps to define the best treatment options. 1. Introduction Pseudoaneurysm of inferior epigastric artery (IEA) is a very rare clinical entity, with just a few cases reported in the literature. It is described as a complication of surgery, trauma, arterial puncture, paracentesis, and removal of Tenckhoff catheters and sometimes is idiopathic. IEA pseudoaneurysm can be diagnosed by a contrast enhanced computer tomography (CT) scan or by a color Doppler ultrasound (US). The treatment options include surgery with excision and ligation of IEA, percutaneous embolization with placement of metallic coils or with N-butyl cyanoacrylate (NCBA), percutaneous thrombin injection, sonographic-guided compression, and conservative treatment [1–25]. 2. Case Report A 51-year-old male marble cutter, with chronic hepatopathy HBV-HCV related, HIV infection, hypertension, and chronic obstructive pulmonary disease, developed end-stage HIV nephropathy. The patient had no prior surgical treatment. The patient started dialysis in 2009. In 2010, he was considered for kidney transplant. In consideration of comorbidities, angiographic-CT scan was performed and detected a 8？mm pseudoaneurysm of left IEA close to the vassel origin (Figure 1). The patient did not refer to pain or discomfort; no tender mass was detected at palpatory examination. Kidney transplant was performed approximately 20 months after trough a “hockey stick” incision; renal graft was anastomized to common-iliac vessels. Contemporary IEA ligation at vassel origin and pseudoaneurymectomy were performed (Figure 2). Postoperative course was regular. During hospitalization, a renal tract US was performed in 4th and 10th postoperative days and no perigraft or pericystic fluid collection was detected. Hospitalization time was 12 days and at the discharge creatinine serical level was 1,4？mg/dL, haemoglobin 13,6？g/dL. At 1 month, creatinine level was 1.2？mg/dL. Figure 1 Figure 2 3. Discussion The IEA arises as a branch of the external iliac artery just above the inguinal ligament. From its origin, it courses upward
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