Most small popliteal venous aneurysms are discovered incidentally during duplex imaging studies and are usually asymptomatic. There is an associated high incidence of venous thrombosis and pulmonary embolism in patients with popliteal venous aneurysms. Preoperative diagnostic studies include duplex venous imaging and magnetic resonance venography (MRV). Aneurysms greater than 2 cm require repair. Aneurysm resection and end-to-end anastomosis are feasible in patients with associated redundant length of the vein proximally and distally. Tangential aneurysmectomy and lateral venorrhaphy are also suitable options. In the presence of thrombus, open thrombectomy before plication is performed. Posterior approach is preferable.