The importance of dams is rapidly increasing due to the impact of climate change on increasing hydrological process variability and on water planning and management need. This study tackles a review for the concrete arch-dams’ design process, from a dual sustainability/safety management approach. Sustainability is evaluated through a design optimization for dams´ stability and deformation analysis; safety is directly related to the reduction and consequences of failure risk. For that, several scenarios about stability and deformation, identifying desirable and undesirable actions, were estimated. More than 100 specific parameters regarding dam-reservoir-foundation-sediments system and their interactions have been collected. Also, a summary of mathematical modelling was made, and more than 100 references were summarized. The following consecutive steps, required to design engineering (why act?), maintenance (when to act) and operations activities (how to act), were evaluated: individuation of hazards, definition of failure potential and estimation of consequences (harm to people, assets and environment). Results are shown in terms of calculated data and relations: the area to model the dam–foundation interaction is around 3.0 Hd2, the system-damping ratio and vibration period is 8.5% and 0.39 s. Also, maximum elastic and elasto-plastic displacements are ~0.10–0.20 m. The failure probability for stability is 34%, whereas for deformation it is 29%.