OBJECTIVE: Brachial artery aneurysms are rare entities that have typically been associated with trauma, infection, arteriovenous fistula creation, or connective tissue disorders. These aneurysms are often asymptomatic, but they can also cause local tenderness or thrombo-embolic events. Due to the very low incidence of true brachial artery aneurysms, there are no standardized guidelines on their optimal management. METHODS: From August 2000 to July 2022, all patients with a diagnosis of true brachial artery aneurysm were managed within our health care system. Demographic information, imaging findings, and operative details for these patients were collected. RESULTS: Twenty-three patients with a diagnosis of true brachial artery aneurysm were identified. The median age was 50.4 years (range, 1-75 years). Eighteen patients (78%) were male, and the mean body mass index was 25.8 ± 6.5 kg/m CONCLUSIONS: Brachial artery aneurysm is diagnosed more commonly in male patients and in those who have a history of arteriovenous fistula creation or connective tissue disorder. Surgical repair of true brachial artery aneurysms should be recommended in all symptomatic patients. In asymptomatic patients, surgery was offered in the presence of aneurysms with intraluminal thrombus and diameter larger than 2.5 cm, with low morbidity. The type of repair is dictated by length of the aneurysm and presence of brachial artery redundancy, with patency of 81% at 2.4 years median follow-up.