Arterial and venous lesions are observed more readily in penetrating and high-velocity traumas. The development of endovascular techniques and mini invasive approaches also explains the increasing occurrence of iatrogenic injuries.

The upper limbs would be involved in 25 % of cases among civilians versus 34 % in the military.

The immediate consequence can be external or internal bleedings but also limb ischemia which can lead to irreversible damage if not managed rapidly.

Crushing, wrenching, and stretching produce limb contusions and/or lacerations which can involve long vascular segments sometimes resulting in a dissection. An extensive thrombosis can occur and sometimes be complicated by peripheral embolisms.

Traumatic hemorrhages can be exteriorized or contained within pulsatile hematomas, constituting false aneurysms, with the risk of delayed rupture. Concomitant arterial and venous injuries can bring about an arteriovenous traumatic fistula, which is at risk of rupture but also of cardiac complications and downstream ischemic consequences.

Finally, an isolated spasm can be depicted; in these cases associated lesions must be looked for to explain ischemia.

If the peripheral vascular traumatism occurs in a polytrauma context, the diagnostic and therapeutic strategies depend on the overall patient assessment (see also Chap.​ 21).

In patients with isolated limb traumas, the diagnosis is primarily based on the clinical work-up. However, a normal clinical examination does not formally exclude any vascular injury, so should the slightest doubt exist, a complementary noninvasive imaging (ultrasound or CT) will be carried out.

In case of clinical suspicion of limb traumatism with associated vascular injury, bones X-rays plain films are very often carried out as the first-line investigation. Doppler ultrasound can easily and quickly explore the peripheral vessels. Angio CT also depicts the bones and the soft tissues, with a good negative predictive value. But invasive arteriography remains the Gold Standard, because it is very sensitive and specific. Its indications were until recently very large, in substitution for systematic surgical exploration; nowadays in many teams they are more elective, exposing to a higher rate of missed injuries and delayed diagnosis, and making follow-up crucial.

Moreover, diagnostic arteriography has now become more often the first step to an endovascular treatment.