Vascular injuries in children result from invasive procedures, penetrating trauma, and blunt injuries. Depending on local practice patterns, these injuries are managed by a range of subspecialists with little guidance from the literature on the optimal approach to diagnosis and management of these challenging injuries. Recently, more aggressive operative approaches to managing injuries in the young have been advocated and have been supported by recent reports from several series of wartime vascular injuries involving children. This review summarizes the scope of both iatrogenic and traumatic vascular injuries and the historic and current literature on these topics. Treatment strategies are also reviewed placing emphasis on the transition from ligation or heparinization to the current trend of managing suspected vascular injuries with operative exploration and repair, including, in some instances, endovascular diagnosis and intervention. Future directions for clinical research in this area are also discussed, which will hopefully promote more multidisciplinary collaboration in this area.