True posterior tibial artery aneurysm is an extremely rare pathology. A fifty-three-year-old Bahraini female presented with a pulsatile mass behind the left medial malleolus for one year duration. Arterial duplex and angiogram revealed a true saccular aneurysm of the posterior tibial artery. The aneurysm was resected and the posterior tibial artery was reconstructed with end-toend anastomosis.
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