Background: Traumatic vascular injuries, seldom but potentially life-threatening, pose diagnostic and therapeutic challenges. Injuries of large vessels with consecutive haemorrhagic shock are the most frequent cause of traumatic cardiac arrest. Vascular injuries are predominantly located at the limbs and manifest themselves via bleeding or ischemia. Results: Preclinical diagnostic and therapeutic possibilities, except external bleeding control are limited. Therefore, early transportation to a convenient clinic is mandatory for successful management. Paramount for clinical management is identifying or excluding vascular injuries. The classification of the patient into stable, borderline, unstable or in extremis guides the surgical principals. Unstable and in extremis patients receive immediate haemostasis via Damage Control principles and haemodynamic stabilisation. Minimal diagnostics (X-ray, FAST) can be helpful. Emergency surgical measures for haemostasis are primary suture, ligature, abdominal/extraperitoneal pelvic packing, balloon catheter tamponade, REBOA, aortic clamping and temporary intravascular shunting. Stable or borderline patients are treated via the primary multislice contrast CT scan and Early Adapted Care surgical principals. In doubtful or suspicious clinical situations and vascular injury typical injury pattern, occult vascular injuries must be definitively excluded via advanced diagnostics. Conclusion: Cornerstones for successful management of traumatic vascular injuries are a functioning rescue chain, interdisciplinary management, quick diagnostics and adequate therapy.