Aberrant right renal perfusion from right internal mammary artery

Renal artery (RA) anomaly is common and may have significant clinical implications. We present a case of a 29-year-old man in whom the upper two-thirds of the right kidney were supplied by the right internal mammary artery and collateral network. Additionally, the superior left RA had proximal stenosis with a distal aneurysm. Renin sampling confirmed renovascular hypertension. He successfully underwent aorta-to-superior right RA bypass and primary repair of superior left RA aneurysm. This case adds to existing knowledge of RA anomalies, and underscores the importance of comprehensive evaluations for alternate renal blood supply for effective surgical management of renovascular hypertension.