Tielliu et al report, in this issue of the Journal of Vascular Surgery, their innovative experience with the endovascular treatment of 57 popliteal aneurysms in 48 patients. They used an open groin incision to expose the ipsilateral femoral artery and to deliver self-expanding nitinol-supported polytetrafluoroethylene stent grafts to exclude the aneurysms. Their early results were improved when clopidogrel was added to the regimen, and it was their opinion that the endovascular procedure should be the first treatment option, irrespective of the availability of the saphenous vein. The objectives of treatment of popliteal aneurysms are to eliminate the embolic source, rupture potential, and mass effect produced by the aneurysm and to provide adequate distal limb perfusion—all in a durable fashion. Although the early results reported by Tielliu et al are reasonable, it seems premature to abandon the traditional approach for good-risk patients with an adequate saphenous vein. In this report, mean follow-up was only 2 years, and the cumulative primary patency at that time (77%) is arguably inferior to that with standard therapy. Although the authors advised against knee flexion more than 90°, complications such as stent migration or fracture were observed. This raises concerns regarding the durability of the metal stent and the synthetic graft, which are required to cross the knee joint. Consequently, the 5-year patency may not be as high as the authors project. In the current series, this endovascular approach was not applicable for 15% of the aneurysms and may be particularly problematic for patients with popliteal aneurysms and associated diffuse arteriomegaly. Furthermore, there is increasing awareness that, after open popliteal aneurysm repair, the ligated aneurysm sac may continue to enlarge, probably through continued pressurization via geniculate collaterals. The mechanism for this observation may be equivalent to that causing aneurysm expansion in the presence of a type II endoleak associated with endovascular abdominal aortic aneurysm exclusion. This occurrence may produce symptoms, such as venous compression, from the mass effect, especially if the popliteal aneurysm is large. Ligation of collateral branches or evacuation of mural thrombus may be necessary to preclude this development. The early data supplied by Tielliu et al suggest that endovascular popliteal aneurysm repair is feasible, but its use should currently be confined to patients with suitable anatomy who are at high risk or who have an inadequate autogenous vein. When the technique is used, long-term follow-up with imaging to detect stent graft migration, separation, or aneurysm expansion seems warranted.