*Purpose: We present a case of ex-vivo repair of complex renal hilar saccular aneurysm followed by auto-transplantation of the solitary kidney.

*Methods: The patient was a 48-year-old female who was discovered to have solitary right kidney and 2 saccular renal artery aneurysms near the renal hilum measuring 2.3 cm and 1 cm. CT Angiography showed fibromuscular dysplasia feature of the main artery in addition to 2 aneurysms. in addition, there was an accessory lower pole renal artery. Ex-vivo repair and auto-transplantation was planned. After nephrectomy, the kidney was flushed with University of Wisconsin solution. Back-table dissection further delineated the anatomy identifying adjacent saccular aneurysms entangled in the renal hilum prior to trifurcation to kidney parenchyma (image 1). aneurysmorrhaphies were performed by excising excessive vessel wall followed by reconstruction using fine prolene sutures (image 2). The kidney was auto-transplanted into patient’s right lower quadrant in standard fashion. the accessory artery was separately anastomosed to external iliac artery.

*Results: The patient had an unremarkable postoperative course without needing dialysis. her serum creatinine peaked at 4mg/dL and trended dow to baseline at 0.9mg/dL five weeks post procedure.

*Conclusions: Ex-vivo surgical repair of complex hilar renal artery aneurysms can be successful and durable. The procedure has low morbidity and will preserve renal function.

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