Most infrapopliteal artery aneurysms are pseudoaneurysms. Mycotic aneurysms are associated with bacterial endocarditis. Diagnosis is often made incidentally during diagnostic imaging for unrelated pathology. Thrombosis and distal embolization result in limb-threatening ischemia. Hybrid repair is usually preferable with surgical bypass for associated popliteal aneurysm and stent graft for tibioperoneal trunk aneurysm. Decision to perform open reconstruction or a stent graft depends on the required length of the stent graft for popliteal aneurysm, availability of adequate length, and quality of the GSV. Patients with mycotic aneurysms require excision of the aneurysm and use of autologous conduit for reconstruction with at least a 6-week course of antibiotics postoperatively.