Purpose: To determine the incidence and to describe the clinical presentation of ruptured popliteal aneurysms.Materials and methods: We reviewed the records of 89 consecutive patients, all males, seen between 1958 and 1995 with 124 arteriosclerotic popliteal aneurysms. Most aneurysms presented with symptoms (69124; 55.6%). In six cases (6124; 4.8%) a rupture was present. In addition, a review of the current literature was made.Results: Clinical presentation differed widely with primary diagnosis varying between deep venous thrombosis and peroneal nerve palsy. In all cases, primary reconstructive surgery was performed. No secondary amputations were necessary. Surgical outcome was good in four cases. In the remaining cases one patient suffered from a permanent peroneal nerve palsy and one from non-disabling claudication. A review of the literature revealed a rupture incidence of 2.5% (range 0-16%). Misdiagnosis leading to delay and/or inappropriate treatment occurred in many patients. As a consequence, amputation rates reported were as high as 100%.Conclusion: An acute rupture of a popliteal aneurysm is rare. Timely intervention offers patients with an acute rupture the best hope of limb salvage, and rapid diagnosis is prerequisite. However, accurate diagnosis can be difficult, even in patients with non-specific popliteal pain, and a pulsatile popliteal mass on presentation.