Aneurysm at the level of the renal arteries ( occlusion of the right renal artery and left renal artery arising from the aneurysm)-

Infra renal abdominal aortic aneurysms are common and relatively they are considered to be straight forward operations technically. But when the renal arteries are involved we need to do the addition planning to preserve the kidneys (at least one kidney) and repair the aneurysm. In the patients (see figure CT angio) there is occlusion of the right renal artery and left renal artery is arising from the aneurysm. The origin of the superior mesentric artery is abutting on the upper margin of  the aneurysm. In such a situation we need to plan to re-implant the left renal artery to the graft or auto transplant the kidney. Preservation of the right kidney is questionable when the artery is already for a very long time.