Renal artery aneurysms (RAAs) represent a rare disease and are most commonly discovered as an incidental imaging finding. RAA may be associated with hypertension and are usually asymptomatic at presentation but may result in rupture, hematuria, or renal infarction. The natural history of RAA is poorly understood. Although there is general consensus that RAA that are symptomatic or identified in women at risk for pregnancy should be repaired, diameter criteria for repair of asymptomatic RAA are controversial and emerging evidence suggests that rupture incidence is low for those <2.5 cm in diameter. Options for repair of RAA have expanded over the preceding decades with expansion of both open surgical and endovascular treatments.