Visceral artery aneurysms (VAAs) are rare but typically originate from splenic, hepatic, superior mesenteric, or celiac arteries. VAAs are predisposed by atherosclerosis but vasculitis and connective tissue disease are also risk factors. Splenic artery aneurysms are most common, and their highest risk of rupture is in pregnant patients. Initial presentation may be vague. VAAs are usually found incidentally, though they can resemble ruptured abdominal aortic aneurysms (AAA) and present as an acute abdomen. Indications for intervention are based on risk for rupture, embolic event, or thrombosis. Seek repair with any symptomatic aneurysm; all pseudoaneurysms; splenic artery aneurysms >2 cm (or VAAs in pregnancy or women of childbearing age); hepatic artery aneurysms >2 cm (or if associated with polyarteritis nodosa); and any celiac, superior mesenteric, jejunal, ileal, or colic artery aneurysm. Endovascular therapy may be first-line therapy in stable, non-ruptured patients, but patients with an acute abdomen require urgent open surgical repair. There are no current trials to compare outcomes between the two techniques, but be prepared to gain access and perform aneurysm exclusion for the most common VAAs.