Renal hypothermia achieved using cold (4 degrees C) heparinized Ringer's lactate is an effective method of preventing renal compromise during abdominal aortic surgery. We present the case of a 62-year-old man with an abdominal aortic aneurysm (AAA), complicated by involvement of an ectopic right renal artery with a low abdominal aortic origin and passage across the ventral side of the inferior vena cava. The patient underwent AAA repair and right renal artery reconstruction using renal perfusion with cold heparinized Ringer's lactate, and no deterioration of renal function occurred.