Pseudoaneurysm formation, which occurs infrequently in the renal transplant patient, can have a catastrophic outcome. We report a case of a large, symptomatic transplant renal artery pseudoaneurysm that was treated by excision with extracorporeal vascular repair and delayed allograft autotransplantation. We review the management of transplant renal artery pseudoaneurysms and the role of delayed autotransplantation in complex reconstructive renal surgery.