A 53-year-old woman was admitted for evaluation of a pulsating abdominal mass. She had visited the emergency department complaining of a racing heartbeat and headache, which had bothered her on and off for 4 years. She was normotensive. A workup for palpitation was negative; however, the physical examination found a pulsating abdominal mass in the right periumbilical area. A computed tomography angiography (Cover) showed a 2.3 1.7-cm sized saccular aneurysm in the right renal artery, which was confirmed by renal angiography (A). Her elder sister had died of subarachnoid hemorrhage due to rupture of a cerebral artery aneurysm. Intracranial imaging was negative for cerebral aneurysm in this patient. Under general anesthesia, a midline laparotomy incision was made, and an extended Kocher maneuver was used to expose the right renal hilum. After dissecting the saccular aneurysm on the right renal artery (B), surgical angioplasty was done by aneurysmorrhaphy, end-to-end anastomosis of the renal artery, and end-to-side anastomosis of the branch to the lower pole of the right kidney. Although the postoperative computed tomography angiography (C) showed a minor perfusion decrease and possibly a small upper pole infarction, the serum creatinine level was unchanged. The patient is doing well after full recovery.