In most cases of renal artery aneurysm rupture, nephrectomy is necessary due to hemodynamic instability. Left nephrectomy was to be avoided at all costs in this patient with an effectively solitary kidney (see past history). Emergency endovascular treatment with a covered stent was considered, but not attempted due to the position of the aneurysm at a branching point. 

Autotransplantation following extracorporeal reconstruction is a recognized treatment for complex hilar or intrarenal aneurysms that involve multiple arterial segments where in situ exposure of the renal hilum can be difficult.  Autotransplantation has also been reported in selected emergency cases over the years.