A left renal artery aneurysm (RAA) was incidentally discovered in a 50-year-old hypertensive woman at renal artery duplex scan. The computed tomography angiography scan confirmed an eccentric, 2-cm large aneurysm localized on a prehilar branch with a very twisted and coiled main renal artery. The selective digital subtraction angiography allowed a better understanding of the local complex anatomy; a covered stent was placed with the complete exclusion of the aneurysm. Even if open surgery still represents the treatment of choice, endoluminal approach has been reported as an effective procedure especially in consideration of its low invasiveness. The exclusion by covered stent can be a safe alternative to coil embolization in case of distal RAAs as well.