Control of the renal vascular pedicle in a context of severe renal trauma in a haemodynamically unstable patient is difficult due to the large retroperitoneal haematoma. Laparotomy in these exsanguinated patients is associated with a risk of cardiac arrest due to hypovolaemia. The authors describe an endovascular aortic balloon catheter occlusion technique prior to laparotomy for haemostasis nephrectomy in a haemodynamically unstable patient presenting an abdominal compartment syndrome. In the light of this case, the authors discuss vascular control in the context of surgical management of severe renal trauma.