Background: The purpose of this study was to describe a case of an endovascular exclusion of a ruptured type II renal artery aneurysm in a hemodynamically unstable patient using an endograft. Methods and Results: A 73-year-old woman, with an extensive medical history, presented with a sudden onset of abdominal pain and hypovolemic shock. A computed tomography scan showed a massive right-sided retroperitoneal hematoma and a type II aneurysm of the right renal artery just proximal to the bifurcation. Angiography demonstrated active contrast extravasation from the aneurysm. The aneurysm was excluded using a 5-cm long, 6-mm wide endograft. After a 6-month interval, duplex ultrasonography showed a patent endograft and normal perfusion of the renal parenchyma in the lower and middle pole, with a glomerular filtration rate of 75 mL/min. Conclusion: Endovascular exclusion using an endograft may provide a safe and rapid alternative to surgery to treat ruptured renal artery aneurysms in a selected group of patients.