Pseudo Aneurysm of the arterial anastomosis is a rare complication seen in less than 1% of recipients and pseudo aneurysm of ileofemoral thrombosis is even rarer. Herein, we report a case of pseudo aneurysm of the anastomotic site following renal transplantation with extensive ileofemoral thrombosis with literature review. The intension of this paper is to provide an update on the varied clinical presentation, early diagnosis and management of this rare case presentation.