We report our experience of surgical treatment of arterial complications after renal transplantation, in 154 patients operated on between 1970 and 2003. The arterial complication was discovered during a routine post-transplant check-up, or when the patient developed clinical manifestations (arterial hypertension, impaired renal function, arterial symptoms in the lower limbs), or following a septic complication. The following lesions were surgically managed: mycotic aneurysms (N = 5), atherosclerotic aneurysms (N = 13) or obstructions (N = 11) of the aorta and iliac arteries, and stenoses of the artery supplying the grafted kidney (N = 125). The type of arterial repair depended on the complication. There were no postoperative deaths. Three thromboses occurred after reconstruction of a stenotic transplant artery (3/125, 2.4 %), leading to graft loss. During long-term follow-up, atherosclerotic lesions of the iliac arteries worsened below an aortic prosthesis in three patients who required repeated surgery. In two other patients, stenosis recurred on a transplant artery and required re-operation. In one patient, an aneurysm developed in a vein graft and was successfully replaced by an arterial autograft. Late deaths among atherosclerotic patients in this setting are usually due to cardiac causes. In all patients, late chronic rejection may lead to kidney loss and hemodialysis.