Surveillance protocols for renal artery aneurysms (RAAs) vary considerably between institutions, with limited evidence to guide optimal imaging intervals and modalities. As the widespread adoption of advanced three-dimensional imaging techniques has increased the incidental detection of RAAs has drastically increased. While generally accepted to be indolent, the natural history of many RAAs remains poorly defined. Despite this, the life-threatening risk of rupture makes establishing safe, effective, and economical surveillance strategies of utmost important. A retrospective review was performed of patients within Metro North Health who were followed up in the nurse led surveillance clinic. Patients were identified from all the patients with renal artery aneurysms under surveillance from the conception of the clinic in 2014. Inclusion criteria required patients to have undergone at least two surveillance scans. Demographic, clinical, and imaging data were collected and analysed. A total of 41 patients met the inclusion criteria and were included in the study. Aneurysm size ranged from 8-24mm, with a mean diameter at the commencement of surveillance of 13.4mm. The average duration of surveillance was 1409 days. During surveillance, aneurysms demonstrated measurable growth, corresponding to an average growth rate of -0.55 +/- 1.73mm per year. The majority of aneurysms remained stable throughout the surveillance period. No aneurysm ruptures were observed, and no patients underwent intervention during follow-up. In this cohort, renal artery aneurysms minimal growth, with most lesions remaining stable during the study period. Furthermore, this study highlights the significant discrepancy in measurement between different imaging modalities. These findings support a conservative surveillance regime. Further studies with larger patient populations and longer follow-up are required to better define the natural history of RAAs and inform optimal surveillance strategies.