Fenestrated endovascular aneurysm repair with concomitant horseshoe kidney

Horseshoe kidney (HSK) is a rare anatomic anomaly that poses surgical challenges in the setting of abdominal aortic aneurysm repair. An endovascular approach is safer for patients yet carries technical challenge because of variable renal vasculature. We present the case of a patient with an infrarenal abdominal aortic aneurysm and concomitant HSK who underwent successful repair with a custom fenestrated endograft with preservation of a midaortic renal artery. Complex endovascular aneurysm repair options for HSK include chimneys and fenestrated stent grafts. We suggest that the availability of custom fenestrated grafts and ongoing skill enhancement among vascular surgeons may make this approach more favorable.