Abdominal aortic aneurysm with concomitant horseshoe kidney is exceedingly rare. Although open repair was previously the treatment, endovascular aortic repair has become an increasingly popular option. In the current endovascular era, complex aortic pathologies are treatable with selective use of multiple advanced techniques. We present a unique case involving complex endovascular repair of abdominal aortic aneurysm complicated by presence of horseshoe kidney with central renal artery in a patient where an open approach was prohibited.