Arterial injuries represent a formidable challenge to surgeons working in war zone conditions. A series of 23 consecutive patients with combat wounds from the Afghan conflict with acute arterial injury were treated at the ICRC hospital in Peshawar. The mean injury-treatment delay (lag time) was 34 hours, with 14 of the 23 patients (60%) treated more than 12 hours after injury. The overall amputation rate was 65%, but only 22% for patients revascularized within 12 hours of injury and 93% for those undergoing surgery after 12 hours. This was a highly significant statistical difference (Chi-square > 13.0, p < 0.005). We recommend attempting revascularization procedures only in patients seen within 12 hours of sustaining a military-type injury to an artery in an extremity.