Objective: To compare the clinical efficacy of open surgery and endovascular repair for popliteal artery aneurysm. Methods: The clinical data of 33 patients with popliteal artery aneurysm treated from January 2008 to December 2017 were retrospectively analyzed. Of the patients, 22 cases (23 limbs) underwent open surgery (open surgery group) and 11 cases (13 limbs) received endovascular repair (endovascular repair group). The general data, perioperative variables and follow-up results of the two groups of patients were analyzed and compared. Results: The age and proportion of cases with concomitant hypertension were significantly greater in endovascular repair group than those in open surgery group (χ2=8.250, P=0.008; χ2=6.203, P=0.024), while no significant differences were noted in terms of other concomitant diseases, preoperative diameter of aneurysm and wound complications between these two groups (all P>0.05). All patients in open surgery group and 6 patients (54.5%) in endovascular repair group underwent operation under general anesthesia (χ2=12.257, P=0.002). The length of postoperative hospital stay and total hospital stay in endovascular repair group were significantly reduced compared with open surgery group (t=–4.221, P=0.000; t=–3.090, P=0.002). Mean follow-up time was 36 months (1 month to 120 months), during which time, 5 patients in open surgery group received reintervention, of whom, 2 cases underwent major amputations; 2 patients received reintervention in endovascular repair group. Kaplan-Meier curve showed that there was no significant difference in freedom from reintervention between these two groups (P>0.05). Conclusion: For PAA patients with advanced age, high risk from open surgery, appropriate anatomic conditions and favorable outflow vessels, endovascular repair may be a safe alternative to open surgery, which has demonstrable efficacy with a short length of hospital stay and rapid perioperative recovery.