Extra corporeal replacement of the renal artery for the treatment of complex renal artery diseases offers numerous advantages: safe approach for the branches of the renal artery and division of the intra-hilar arteries, easy repair and sutures, excellent quality of intra-operative arteriogram, easy repair of venous damage, excellent renal preservation. These advantages and the excellent long term results justify extra-corporeal surgery as the procedure of choice for the treatment of complex renal artery disease.