Abstract: Research findings indicate that radiotherapy is a crucial treatment modality for nasopharyngeal carcinoma (NPC), however, irradiation inevitably damages surrounding tissues, leading to related complications, particularly the formation of pseudoaneurysms. Accurate monitoring of post-radiotherapy pseudoaneurysm progression, timely implementation of hemostatic measures, and reduction of bleeding volume are critical in management. This review focuses on the mechanisms and clinical management of nasopharyngeal hemorrhage following radiotherapy for NPC, aiming to explore vascular management strategies for post-radiotherapy bleeding in the nasopharyngeal region. For patients with massive hemorrhage, tracheotomy or endotracheal intubation serves as an active and effective emergency intervention; non-massive bleeding may be managed using the step-by-step hemostasis technique. Vascular re-construction encompasses multiple strategies: embolization is the primary approach for extracranial artery bleeding, while intracranial artery bleeding is more commonly managed with stenting or arterial bypass grafting. Arterial bypass grafting offers relative advantages in long-term survival rates, while novel stents demonstrate positive effects in reducing cerebral ischemia and rebleeding risks. For clinicians, selecting the ptimal treatment strategy and actively implementing endovascular management or vascular reconstruction can enhance treatment outcomes for nasopharyngeal hemorrhage following radiotherapy in NPC patients.