This chapter explores vascular injuries in total hip arthroplasty (THA), emphasizing their rarity yet critical implications. It delves into the intricate vascular anatomy surrounding the hip joint and identifies vulnerable regions susceptible to injury during surgery. Mechanisms of injury, including direct trauma and thermal damage from cement polymerization, are discussed alongside predisposing factors such as altered anatomy and previous surgeries. Prevention strategies encompass preoperative assessment, meticulous surgical planning, and intraoperative precautions to mitigate risks. Prompt recognition and management of vascular injuries are essential, necessitating effective communication and collaboration among surgical teams and vascular specialists. Techniques for temporary and definitive control of bleeding are outlined, highlighting the importance of surgical approaches and endovascular interventions. By fostering a comprehensive understanding of vascular anatomy and implementing proactive management strategies, orthopedic surgeons can enhance patient safety and optimize outcomes in THA surgeries.