Missile emboli remain unusual and challenging problems. Failure to recognize and adequately manage these uncommon lesions can result in loss of limb and/or life. No one individual or medical center has an extensive experience with missile emboli. An analysis of approximately 7,500 Vietnam casualties with known vascular trauma revealed an incidence of about 0.3%: 22 patients with missile emboli. The majority were associated with fragments from explosive devices and involved the arterial system. The missile emboli were removed in all but three patients. Only one patient had a vascular complication. There was no mortality or amputation in this series.