A renal artery aneurysm in a stenotic renal artery is a rare clinical entity with an incidence of 0.015% to 1% in patients with renovascular hypertension. Interventional stent placement is the first line of treatment for simple aneurysms of the proximal renal artery. However, renal autotransplantation has been used as an alternative treatment for complex lesions and for lesions originating from the distal renal artery. We present a patient with a renal artery aneurysm, renal artery stenosis of the segmental branches of the left kidney, and occlusion of the right renal artery. The surgical strategy included renal explantation, ex vivo renal preservation, ex vivo reconstruction of the 2 renal artery branches, and renal heterotopic autotransplantation. We conclude that renal autotransplantation is a safe and effective surgical procedure for patients with complex renal arterial disease.