Peripheral vascular injuries, though relatively uncommon, pose significant threats to both life and limb and demand prompt, nuanced management. This chapter outlines the epidemiology, anatomy, classification, clinical presentation, imaging, and treatment strategies for extremity vascular trauma. Initial priorities include hemorrhage control, vascular assessment, and restoration of perfusion, with surgical and endovascular techniques tailored to injury severity and patient stability. Emphasis is placed on operative and nonoperative approaches, damage control in unstable patients, appropriate use of imaging, and vigilant postoperative monitoring to reduce complications such as thrombosis, ischemia, and amputation.