A patient with an abdominal aortic aneurysm associated with horseshoe kidney and duplication of the inferior vena cava is described. Of all the preoperative investigations, CT scan was the most accurate. Operative difficulties stemmed essentially from the abnormal origin of the renal arteries and the functional anatomy of the horseshoe kidney. An anterior approach, as opposed to the posterior approach, allowed easy access to the aneurysmal neck despite the presence of a duplicated inferior vena cava.