Individualized Management of Traumatic Limb Pseudoaneurysms: A Case-Based Comparison of Endovascular and Open Repair

Traumatic limb pseudoaneurysms are rare vascular complications that can cause acute limb ischemia and require urgent treatment. Traditionally addressed through open surgical repair, advances in endovascular techniques have introduced less invasive options, particularly beneficial for high-risk patients. This article presents two cases illustrating individualized decision-making in choosing between endovascular and open surgical repair. A comparative case-based approach was employed. The first case involved a 94-year-old male with multiple comorbidities and a femoral pseudoaneurysm following blunt trauma. Due to anesthetic risk, endovascular repair with overlapping stent grafts was performed. The second case described a 34-year-old male with a delayed presentation of a traumatic axillary artery pseudoaneurysm. Open surgical exploration and autologous vein graft interposition were undertaken. In the elderly patient, the endovascular approach achieved rapid exclusion of the pseudoaneurysm, with restoration of limb perfusion and no postoperative bleeding. In the younger patient, open surgery successfully re-established arterial continuity and function. Some residual sensory deficits persisted due to delayed presentation, but follow-up showed good perfusion and no signs of ischemia. These cases highlight the importance of patient-specific management. Endovascular repair offers a minimally invasive solution with lower perioperative risk, especially suitable for elderly or frail patients. Open surgery remains essential for durable reconstruction in young, otherwise healthy individuals or in anatomically complex cases. Selection of the optimal approach depends on age, comorbidities, pseudoaneurysm location, and time from injury to presentation. Traumatic pseudoaneurysms require individualized management strategies. Minimally invasive repair is generally reserved for patients at elevated surgical risk, whereas open repair remains a durable option for younger, healthier individuals. These cases reflect the need for flexible, evidence-informed decision-making in vascular trauma. With limited large-scale data and standardized protocols, further research is needed to guide optimal treatment strategies.