Conventional open surgery remains the first-line treatment for popliteal artery aneurysms, offering durable and reproducible results across a wide range of clinical presentations. The standard surgical principle relies on aneurysm exclusion combined with arterial reconstruction, using autologous or prosthetic conduits, or arterial transposition techniques.

Autologous vein bypass, most commonly using the great saphenous vein in a reversed or in situ configuration, is widely regarded as the reference technique. It provides excellent long-term patency, superior limb salvage rates, and a low risk of infection, particularly in patients with compromised distal runoff or acute ischemic presentations.

Femoral artery transposition constitutes an effective alternative to venous bypass in carefully selected patients. By resecting the aneurysmal segment and using the superficial femoral artery for direct reconstruction, this technique preserves autologous arterial tissue and avoids the use of prosthetic material. It may offer durable patency comparable to vein bypass, while eliminating vein harvest; however, it is technically demanding and limited by anatomical constraints, including arterial length and quality.

Prosthetic grafting remains an available option when autologous solutions are not feasible. In this setting, prosthetic material is intentionally positioned outside the popliteal fossa, with proximal and distal anastomoses performed away from the knee joint to reduce mechanical stress and improve durability.