Exclusion of an infrarenal AAA with coincident horseshoe kidney and renovascular anomalies is feasible using a standard stent-graft.

INTRODUCTION: Aberrant renovascular anatomy due to a horseshoe kidney becomes challenging during endovascular aneurysm repair. REPORT: A 65-year-old man presented with a horseshoe kidney overlying a 6.1 cm abdominal aortic aneurysm, with the inferior vena cava anterior to both aneurysm and kidney. The left renal artery shared a common origin with the inferior mesenteric artery. Management was by endovascular repair with precannulation of the common left renal/inferior mesenteric arterial origin as a strategic marker, allowing deployment of a standard bifurcated stent-graft. DISCUSSION: Innovative endovascular/fenestrated/sidebranching techniques make issues of aberrant anatomy redundant and reduces surgical morbidity; with relatively simple anatomy precannulation of aberrant vessel(s) guides deployment of the top end of a standard stent-graft.