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Juxtarenal aortic aneurysms (JAAs) have been conventionally treated using open repair with excellent results. Recent approval of fenestrated stent grafts by the United States Food and Drug Administration has given patients with JAAs an alternative for repair. However, most of these procedures are still performed under general anesthesia, making some surgeons reluctant to offer repair to a subset of patients deemed too high risk for general anesthesia. We present three patients with JAAs at high surgical risk, including one patient with a ruptured aneurysm, who were successfully treated using a fenestrated stent graft under regional anesthesia.