uxtarenal aortic aneurysms (JRA) account for approximately 15% of abdominal aortic aneurysms. 1 By definition, suprarenal aortic crossclamping is required for surgical repair, causing temporary renal artery occlusion that may lead to postoperative renal dysfunction, in some case requiring (temporary) hemodialysis. Standard endovascular aneurysm repair (EVAR) is not an option due to inadequate landing zone for the graft below the renal vessels. Hence fenestrated and branched aortic endografts have been developed to treat high risk patients unfit for open surgery and anatomically unsuitable for standard EVAR. However, procedures are complex, technically challenging, and time consuming. 2,3 Case Report A 74-year-old man with a past medical history of hypertension, dyslipidemia, ischemic heart disease, chronic renal insufficiency and peripheral vascular disease, underwent right total knee replacement in March 2018. Postoperative kidney ultrasonography was performed due to renal insufficiency which revealed an abdominal aortic aneurysm. His computed tomography (CT) scan of the thorax, abdomen, and pelvis showed a large pararenal abdominal aortic aneurysm (7.8x6.8 cm) (Figure 1).