Background: Popliteal artery aneurysm (PAA) represents 1% in men. Bilateral conditions occur in more than 50% the cases.  The most common cause of such aneurysms is atherosclerosis. About 80 % of the PAAs are asymptomatic at the time of diagnosis while 20% carry high risk for thrombosis and amputation subsequently. Objectives: This study was conducted to compare the medial and posterior approaches in management of popliteal artery aneurysm repair. Patients and methods: 40 cases of PAAs were included. Medial approach was done in 20 cases and posterior approach was done to the other 20 cases. Carful history taking and clinical examination was done for proper assessment. Results: primary patency after 30 day was 100 % with average hospital stay 3.5 days. In the post-operative period, there was few complications with medial approach where one wound hematoma occurred. One asymptomatic graft thrombosis after 11 months occurred. One patient required   angioplasty at 24 months with stenting of the distal anastomosis. Graft complications with posterior approach was minimal including one wound seroma, one distal showers in the anterior and posterior tibial arteries at 10 months, one case required balloon angioplasty to the proximal anastomosis at 17 months. Conclusion: After 6 months, there was no significant difference between the two approaches but if we take in consideration the risk of persistent PAA growth (up to 25%) after the medial approach, the posterior approach might be the preferred.