Boneva Bistra, Ilchev Boris
Vascular Surgery, National Cardiology Hospital, Sofia, BGR.
Vascular Surgery, Acıbadem City Clinic Tokuda Hospital, Sofia, BGR.
Cureus. 2025 Jul 30;17(7):e89065. doi: 10.7759/cureus.89065. eCollection 2025 Jul.
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.
创伤性肢体假性动脉瘤是罕见的血管并发症，可导致急性肢体缺血，需要紧急治疗。传统上通过开放手术修复来处理，血管内技术的进步引入了侵入性较小的选择，这对高危患者尤其有益。本文介绍了两例说明在血管内修复和开放手术修复之间进行个体化决策的病例。采用了基于病例的比较方法。第一例涉及一名94岁男性，有多种合并症，钝性创伤后出现股部假性动脉瘤。由于麻醉风险，采用重叠支架移植物进行血管内修复。第二例描述了一名34岁男性，创伤性腋动脉假性动脉瘤出现延迟。进行了开放手术探查和自体静脉移植介入。在老年患者中，血管内方法迅速排除了假性动脉瘤，恢复了肢体灌注，且无术后出血。在年轻患者中，开放手术成功重建了动脉连续性和功能。由于出现延迟，仍存在一些残留感觉障碍，但随访显示灌注良好，无缺血迹象。这些病例突出了个体化管理的重要性。血管内修复提供了一种微创解决方案，围手术期风险较低，特别适合老年或体弱患者。开放手术对于年轻、健康个体或解剖结构复杂的病例进行持久重建仍然至关重要。选择最佳方法取决于年龄、合并症、假性动脉瘤位置以及受伤至就诊的时间。创伤性假性动脉瘤需要个体化管理策略。微创修复通常适用于手术风险较高的患者，而开放修复对于年轻、健康的个体仍然是一种持久的选择。这些病例反映了在血管创伤中需要灵活的、基于证据的决策。由于大规模数据和标准化方案有限，需要进一步研究以指导最佳治疗策略。
