*Purpose: In this study, we review our centers experience with complex renal artery aneurysms using our preferred technique of open nephrectomy, ex vivo repair, and autotransplantation in the pelvis.

*Methods: The records of 11 consecutive cases of hilar RAA treated at our center between 2012 and 2020 were reviewed retrospectively. In each case, an open nephrectomy and partial ureterectomy was performed through an 8 cm flank incision. The affected organ was flushed with ice cold Belzer UW solution. Ex vivo resection of RAAs and reconstructions were performed on the back table in an ice bath. Autotransplantation was performed immediately after repair in the pelvis via a Gibson incision. Demographic data, intraoperative details, short term and long term outcomes are reported.

*Results: During the study period, 11 ex vivo renal artery aneurysm repairs and autotransplantation procedures were performed in 10 patients. The median age of the patients was 56 years (interquartile range 47 – 66 years). Nine patients had at least 1 major cardiovascular comorbidity. The right kidney was involved in 5 cases, the left kidney in 6 cases. One patient had bilateral RAAs that were addressed in a staged manner. The total ischemia time was 303 ± 79 minutes. The mean aneurysm size measured by largest diameter in cross sectional imaging was 27.0 ± 8.5 mm. The mean pre-operative serum creatinine was 0.77 ± 0.14 mg/dL. Seven RAAs were repaired by aneurysmorrhaphy, 3 were implanted using a common patch, and in one case a combination of techniques was used. The mean serum creatinine at discharge on post-operative day 3 was 1.12 ± 0.98 mg/dL. Post-operative length of stay was 3 ± 0 days. Only one graft loss was reported due to microembolic disease in the kidney requiring graft nephrectomy. No patients progressed to chronic kidney disease or required dialysis during the study period. There were no deaths during follow up.

*Conclusions: Ex vivo repair and autotransplantation is a treatment modality for complex hilar RAAs which has low complications and excellent outcomes.

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