Sarcomas are rare malignant tumors originating from various mesenchymal tissue types and are hence extremely heterogeneous in the histomorphology, radiological presentation, clinical and oncological behavior as well as location. Curative treatment requires as a rule radical surgical tumor resection in the sense of a compartmental resection or wide excision. The surgical resection and defect reconstruction can be technically demanding depending on the anatomical proximity to neighboring essential neurovascular structures. This situation must be planned and solved in an interdisciplinary approach. Advances in multimodal treatment concepts as well as biological reconstruction or endoprosthetic replacement for large peripheral osseous defects, often enable extremity-preserving operations; however, in sarcomas showing circumferential encasement of vascular structures, vascular resection and reconstruction is an absolute prerequisite for attainment of clean surgical margins (R0). Meanwhile, modern osteosynthetic, arthroplasty or vertebral body replacement systems allow reconstruction of multiple vertebral segments, pelvic or large joints. This article presents and discusses aspects of the contribution of vascular surgery for the treatment of mediastinal, retroperitoneal and peripheral sarcomas. In addition to vascular replacement procedures for extremity or organ salvage, the establishment of an adequate ventral access route, e.g. in spinal and pelvic tumors, can also make it necessary to include a vascular surgeon in the interdisciplinary team.