While venous aneurysms of the deep system in the lower extremities are well recognized as a risk for thrombosis and PE, aneurysms of the GSV also carry this risk. Sequelae of thrombosis and PE are most frequently reported in addition to symptoms associated with mass effect and venous reflux. Often these patients present for surgical evaluation of a hernia or soft tissue mass and the diagnosis is sometimes missed. With more patients undergoing duplex interrogation of their lower extremities, venous aneurysms of the lower extremities are being found with increasing regularity. A diagnostic confusion with other etiologies (i.e. soft tissue masses, inguinal hernias), and delayed in definitive therapy, could both affect prognosis just like in the case of our patient. Delay in diagnosis or surgical therapy increase the risk of thromboembolism and death.The natural history of these aneurysms is uncertain and, as such, management is variable. A review of the literature revealed management strategies ranging from chronic anticoagulation to ligation with or without excision to excision with interposition grafting with the goal to preserve the continuity of the GSV. In the popliteal vein, the risk of PE despite therapeutic anticoagulation with Coumadin is as high as 30%. There are several case reports of PE from aneurysms of the GSV despite anticoagulation. In the majority of patients it would seem that excision with SFJ ligation would provide the most durable and expedient solution with a low overall risk of morbidity and mortality. We admit however that some bias cannot be excluded from our comments and therefore, further study of the natural history and the methods to treat these aneurysms is warranted.Pathologic descriptions of venous aneurysms are few. Histologic cross sections of a venous aneurysm often show the aneurysm wall to be composed of focally thinned and disorganized smooth muscle with luminal thrombosis in some cases.