Despite a nationwide 55 mph speed limit, and amid rising interpersonal violence, vascular injuries exact a great toll in morbidity and mortality. The identification, anatomic diagnosis, and repair of civilian traumatic vascular injuries still present a challenge.The concepts and precepts concerning vascular injury learned during World War II were responsible for the improved rates of limb salvage in the Vietnam War and remain pertinent in present-day civilian practice.The key factors concerning clinical evaluation, laboratory diagnosis, and definitive surgical therapy for major vascular injuries are outlined and elucidated.