Park and Kim report the case of a 35-year-old man with a bilateral aneurysm of the extracranial carotid artery treated with resection/great saphenous vein grafting in a staged fashion. The aneurysm of the right carotid artery was correctly treated first, as it was larger and contained a larger amount of intraluminal thrombus than the right one. Access to the aneurysms was gained through a curvilinear, T-shaped incision extending from the mastoid to the mid-neck. Standard pre-ternocleido-mastoid incisions can also be used and coupled to additional maneuvers to improve distal control of the internal carotid artery for aneurysms with distal extension. In this report the anatomical situation of the aneurysm required the section of the digastric muscle alone. When a potentially difficult distal exposure is anticipated at preoperative imaging and workup, nasal intubation can be considered: it allows sufficient enlargement of the distal surgical field in most cases without necessarily being associated with mandibular subluxation or resection. For aneurysms extending to the base of the skull, the distal cervical internal carotid can be controlled with an occluding Fogarty catheter passing within the graft while performing the distal graft-to-internal carotid artery anastomosis. Once the anastomosis is completed, the balloon is deflated, back-bleeding is checked, and the balloon removed. As the distal anastomosis to the distal internal carotid artery is the most technically demanding it may be preferable to perform it first, with the fully mobile graft. This also allows easier tailoring of length and tension of the graft at the moment of proximal anastomosis. Truly juxtacranial or infratemporal aneurysms require surgical exposures such as those described by Fisch and Mercier,2, 3 that are to be performed with the participation of otolaryngologists and require strategies that are different from those of cervical aneurysms.The choice of the graft material is an important issue. Park and Kim chose the great saphenous vein as the arterial substitute with both excellent intraoperative result and postoperative control imaging. The choice of autogenous great saphenous vein is supported by the young age of the patient, its good long term-patency rate, and resistance to infection. It probably remains the best and most widely used graft material in this setting. Limits of the saphenous veins are its tendency to fibrosis or aneurysmal degeneration in the long term. As indicated by the authors in the discussion, a possible alternative could be a polytetrafluoroethylene conduit, a material that has been proven to have fairly good resistance to infections and equally good, long-term patency rates. In older patients it could be a suitable alternative to a lacking or poor-quality autogenous vein. When a suitable autogenous vein is not available and the young age of the patients advises against use of a prosthetic graft, a possible alternative may be represented, in male patients, by a good-quality, atherosclerosis-free superficial femoral artery, replaced by a PTFE graft at the thigh. In women the hypogastric artery could be considered, provided that it is available in sufficient length for bypass and with an adequate diameter to avoid anastomotic and conduit mismatch.In conclusion, Park and Kim are to be congratulated for the timing of surgery of the bilateral disease, the technique, and the excellent result obtained, which are all within the paradigm of treatment for this condition.