Renal Preservation During Open Abdominal Aortic Aneurysm (AAA) Repair in a Patient With a Pelvic Kidney: A Case Report and Surgical Insight.

Repair of an abdominal aortic aneurysm (AAA) becomes significantly more complex when complicated by the presence of atypical renal vasculature and an ectopic kidney, as these anatomic variations pose distinct surgical challenges. In these cases, the surgeon must not only address the aneurysmal part of the aorta but also manage the aberrant renal anatomy to ensure the preservation of kidney function. This is critical in open AAA repair, where prolonged aortic clamping and manipulation near aberrant renal vessels can compromise renal perfusion. Preservation of renal function under these circumstances is technically demanding but essential for a successful outcome. This case report presents a 59-year-old male patient with an infrarenal abdominal aortic aneurysm and a pelvic ectopic kidney, in which the renal artery originated anomalously from the distal aorta. The patient underwent successful open surgical repair with a comprehensive planning and intraoperative strategy tailored to protect renal function while treating the aneurysm, emphasizing the importance of individualized surgical approaches in managing such rare and anatomically complex presentations.