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Renal artery aneurysms (RAAs) are rare, with an estimated incidence of 0.01% to 0.97%. These aneurysms are often asymptomatic, although they occasionally manifest with hypertension, back pain, hematuria, or rupture. Despite limited evidence guiding treatment, women of childbearing age are consistently offered treatment because of the high risk of rupture. We present a case of a woman planning pregnancy with bilateral RAAs after failed endovascular management. She underwent bilateral laparoscopic nephrectomy, ex vivo reconstruction, and autotransplantation for treatment of her aneurysms. This appears to be safe and effective for treatment of RAAs and should be considered in similar patients. (J Vasc Surg Cases and Innovative Techniques 2020;6:126-8.)

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