Sub acute or chronic upper limb ischemia is often non-atheromatous, especially in the young and is of multiple etiologies. Subclavian artery is affected the most in atheromatous/non atheromatous etiologies but brachial artery is most affected in fibro muscular dysplasia of upper limbs. Here we have a 58-year-old man presented with right upper limb claudication for the last 1 year and on investigation found to have bilateral brachial artery occlusions was treated successfully with Percutaneous balloon angioplasty. This is a very rare case of bilateral brachial artery occlusion with a classical beaded appearance of the renal arteries giving the only clue for etiology of fibro muscular dysplasia. Excellent response to balloon angioplasty without stenting was highlighted in this case.