The coexistence of horseshoe kidney and abdominal aortic aneurysm is rare, and technical challenges during aneurysm repair are significant. This is a report of a case of an infrarenal aortic aneurysm associated with a horseshoe kidney with a parenchymatous isthmus draining to a third ureterocaliceal system and an anomalous vascular supply. Surgical management consisted of aneurysm exclusion and use of a bifurcation graft to the common iliac arteries. Arterial supply to the isthmus remained intact during operation and the postoperative clinical outcome was satisfactory.
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