“…1,2 The isthmus overlying the aorta presents many problems for OR 1,2 ; division is associated with risks of urinary leaks, fistula, sepsis and haemorrhage, 1,2 whilst leaving the isthmus intact may make the aorta inaccessible causing difficulty controlling back bleeding. 1,2 70% of HSK occur with renovascular anomalies; most commonly two normal main renal arteries and one accessory vessel arising from the common iliac arteries, 1,3 though the anomalous vessels may vary in number and location. 3 In the past, this has presented obstacles for the surgeon as these accessory renal vessels supply variable portions of the HSK.…”