Trauma to the lower extremity is very common. It accounts for 1–2% of all traumatic injuries in the non-military population (Konstantinidis et al., J Trauma Acute Care Surg 71:909–916, 2011). Lower extremity injuries with concomitant vascular injuries add a level of complexity to the overall management of the patient. The main objective in management is to prevent limb loss and to potentially restore the function of the affected limb. A systematic approach in management ensures that there is no delay in treatment. Patients are triaged based on the hard and soft signs of vascular injury. For example, a hemodynamically stable patient who is found to have a discrepancy in pulse examination (soft sign) should undergo further diagnostic workup to identify the injury if not immediately apparent. Conversely, a stable patient with active hemorrhage (hard sign) is typically taken to the operating room to address the injury. Ultimately, the care of the patient should be approached in a multidisciplinary manner with input from the trauma surgery team, vascular surgery, as well as orthopaedic surgery team when appropriate. This ensures that the patient has a chance at best possible outcome.