The outcome of 961 patients with vascular injuries received in the Afghanistan war is reported. Some 755 (78.6%) patients had to have a primary amputation while only 206 (20.9%) had restorative surgery. The vessels were simply ligated in 85 cases and reconstructive surgery was performed in 121. Ligation resulted in 46 (54%) cases of limb salvage and functional restoration; 30 (35%) went on to amputation and nine (11%) died. Of the 121 patients treated by reconstructive surgery, 83 (68.5%) had completely patent vessels, 19 (15.7%) collateral compensation, 13 (10.7%) proceeded to subsequent amputation and six (4.9%) died. Although the location of the injury and the duration of the ischaemic period are important in deciding how to treat the vascular injuries of war, the decisive factor appears to be the pre-existing severity of regional ischaemia.