Splenic aneurysms are the most common visceral aneurysms, which are usually isolated sacs. Most of them are associated with old age, pregnancy, and increased portal vein blood flow with a high risk of rupture. At present, the choice of the treatment of splenic aneurysms remains controversial. Traditional open surgery is mostly used for emergency ruptures, while endovascular treatment is favored for elective surgery because of the slight trauma and rapid postoperative recovery. Both procedures have their own advantages and disadvantages. Lack of evidence-based medicine results in controversy concerning the treatment of splenic aneurysms. Therefore, further study is needed for the choice of endovascular treatment, long-term therapeutic effect and the application of perioperative anti-coagulant and antiplatelet drugs.