Renal artery aneurysms (RAAs) are rare vascular anomalies characterized by a focal dilation of the renal artery exceeding 1.5 times its normal diameter. Though uncommon, RAAs carry clinical significance, with prevalence estimates ranging from 0.1% to 2.5% in the general population [[1], [2], [3], [4], [5]]. Advances in diagnostic imaging, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have enhanced RAA detection and surveillance, especially in older patients, who may have a higher prevalence due to age-related vascular degeneration and atherosclerosis [6].

While most RAAs are asymptomatic, they carry potential risks, including renovascular hypertension, renal infarction, and rupture. Distal parenchymal embolization occurs in 8% to 11% of cases, with modern rupture rates estimated around 3% to 5% and non-gestational mortality below 10% [3,4,[7], [8], [9], [10], [11], [12]]. In older adults, the management of RAAs presents unique challenges due to age-related vascular changes, including arterial calcification, reduced elasticity, and concurrent comorbidities such as hypertension, diabetes, and chronic kidney disease (CKD) [6,13]. Additionally, older adults do not face the risk of gestational rupture of RAA.

Historically, open surgical repair has been the standard treatment for RAAs that meet the size criteria for repair in individuals with an acceptable operative risk [3]. However, the evolution of endovascular techniques has provided minimally invasive alternatives with lower perioperative risk and faster recovery, which may benefit older patients. While most RAAs remain stable, they exhibit an average annual growth rate of 0.06 to 0.6 mm per year [[14], [15], [16]].

This article reviews the epidemiology, diagnosis, management strategies, and outcomes of RAAs in older adults.