Background: Less than 0.1% of the population experiences a popliteal aneurysm (PA), and the consequences of not treating PA include a significant risk of embolization, thrombosis, and limb loss. Surgical treatment for this vascular disease has produced excellent clinical results, but there remain an increasing number of published reports that continue to question the efficacy of endovascular therapies. Methods: All consecutive patients operated on for PA at our hospital in the years 2000-2007 were reviewed retrospectively for clinicopathological data and applicability for endovascular treatment. Results: Forty-six patients were surgically treated for 56 PAs (42 vein, 11 alloplastic material, and one composite graft). Overall survival rates after 2 and 5 years were 77% and 54%, respectively. Reintervention-free survival rates at 2 and 5 years were 71% and 43%, respectively. Graft patency for veins was significantly higher, with a hazard ratio of 0.025 (95% confidence interval 0.002-0.304, p = 0.004). Twenty-two of the 37 patients (59.5%) with a sufficient angiograph appeared to be eligible for endovascular treatment. Conclusion: Despite the positive results of surgical repair shown in our study and in the existing literature, endovascular treatment has a high technical eligibility with good reported outcomes and represents an alternative for open surgery.