Background: Fenestrated endovascular aortic aneurysm repair (FEVAR) is a standard procedure for the treatment of complex aortic aneurysm. More than 4 fenestrations are still randomly used, even in case of complex aneurysm anatomy involving accessory renal arteries. Methods: We are presenting the case of a 62-year-old male patient suffering from 63-mm juxtarenal aortic aneurysm. Because of his medical history and an ongoing immunosuppressive medication an endovascular approach was conducted. Using a 6-fold fenestrated endograft, 4 renal arteries as well as the superior mesenteric artery and the celiac trunk have been cannulated and stented successfully. Results: No perioperative complications such as impairment of renal function could be observed. After 12 months, still a nonhampered renal function could be assessed. Furthermore, the endoprosthesis showed a good fit without detection of endoleaks, patent fenestrations, and a decreasing aneurysm diameter after 12 months of follow-up. Coverage of accessory renal arteries has been described as an established and necessary technique during endovascular repair of juxtarenal aortic aneurysm; yet coverage of these vessels may be related to renal infarction and an impaired renal function during follow-up. Based on current technical developments the implantation of a 6-fold FEVAR may be conducted with promising results. Conclusions: Six-fold fenestrated stent-graft prosthesis for the treatment of juxtarenal aortic aneurysm involving accessory renal arteries may be a feasible treatment option related to an appropriate 12-month patency.