Objective To investigate the incidence and countermeasures of pseudoaneurysm at puncture site of lawerextremity arteriosclerosis by percutaneous endovascular treatment. Methods A retrospective analysis was performed on the clinical data of 1 692 arteriosclerosis obliterans （ASO） patients （involving 1 845 puncture points） who underwent percutaneous endovascular treatment in the Department of Vascular Surgery，the Affiliated Hospital of Southwest Medical University，from 2012 to 2019. An observation was performed on the incidence and coping strategies of pseudoaneurysms at different puncture points caused by different ways of hemostasis after the operation and during the hospitalization. Results The overall incidence rate of pseudoaneurysms was 4.12% （45 cases in the femoral artery，28 cases in the brachial artery，and 3 cases in the inferior genicular artery）. There was no significant difference between retrograde puncture and antegrade puncture，but the brachial artery had a significantly higher incidence rate of pseudoaneurysms （7.98%），and after manual compression，the formation rate of pseudoaneurysms was significantly higher （5.25% vs 1.58%，P < 0.05）. Manual compression was more commonly used for antegrade puncture and brachial artery puncture. After diagnosis，all pseudoaneurysms were successfully treated through recompression under ultrasonic location，balloon-assisted injection of hemagglutinin，stent covering，coil embolization，and other surgical procedures，and there were no cases of re-rupture. Conclusion The operation time，calcification degree of puncture point，and the preferred treatment of puncture point in patients with lower extremity ASO directly affect the incidence of perioperative pseudoaneurysms. The emphasis and timely and proper treatment of perioperative complications after endovascular treatment of ASO is an effective method to reduce adverse events. Serious complications cauld be avoided by the early diagnosis and treatment of pseudoaneurysms.