The purpose of this study was to investigate the mode of presentation of superficial femoral artery aneurysms, their association with other arterial aneurysms, and their operative treatment.Records of patients with superficial femoral artery aneurysms seen at our institution from 1990 to 2000 were reviewed retrospectively with attention to presenting symptoms, clinical examination, arteriographic findings, and operative management.Eleven of 13 aneurysms (85%) were in men. Nine (69%) were associated with aortic or iliac aneurysms, and seven (54%) with femoral or popliteal aneurysms. Six patients (46%) presented with distal ischemia, four (31%) presented with a thigh mass, and three (23%) were discovered during investigation for other vascular problems. No ruptured superficial femoral artery aneurysms were seen. Eleven patients underwent successful aneurysm resection and bypass grafting. Two patients underwent amputation. There were no operative mortalities.Patients with superficial femoral artery aneurysms may present with distal ischemia, with a pulsatile thigh mass, with rupture and bleeding, or the aneurysms may be discovered during other investigations. The high incidence of complications suggests that resection and grafting should be performed electively, and the frequent association of aortoiliac or peripheral aneurysms mandates thorough investigation and follow-up.