Delayed presentation of a giant temporal artery pseudoaneurysm.

Superficial temporal artery pseudoaneurysms (STA PSAs) are rare vascular lesions typically resulting from blunt trauma. We present the case of an 82-year-old woman on apixaban who developed a massive STA PSA measuring 3.5 cm with overlying skin necrosis and vision changes after a mechanical fall. Urgent surgical ligation, resection, and local tissue rearrangement achieved successful closure and recovery. This case illustrates the potential for delayed growth and natural history of STA PSAs in patients on chronic anticoagulation and emphasizes the importance of timely intervention and multidisciplinary collaboration to optimize outcomes.