Vascular trauma in the military has special importance as combat-related injuries to major vessels offer unique surgical challenges and comprise the majority of potentially preventable deaths on the modern battlefield. The front lines of a battleground are predictably dirty, noisy, and located in predominantly harsh climates. You will routinely perform surgery in tents or abandoned buildings that lack suitable light and ventilation. These austere conditions demand early deliberate preparation to ensure successful management of vascular wounds. Lessons learned during US military operations continue to advance the practice of vascular trauma surgery and now translate into the current recommended surgical practices. Despite the fact that Vascular Surgery has become largely separated from General Surgery, all military surgeons must be well versed in basic vascular anatomy and reconstruction techniques. The majority of combat vascular injuries are not being handled by Vascular Surgeons, and you are unlikely to have one available to guide or assist you. Be prepared, you can be the difference between limb salvage or loss.