Background

Vascular trauma is among the most time-critical problems in surgery, with risk of **exsanguination, ischemia, compartment syndrome, limb loss, and death**. [@rutherford2018]

**Epidemiology and mechanisms**

- Vascular injury occurs in a minority of major trauma admissions, but disproportionately contributes to preventable death due to hemorrhage. [@fox2005]
- Civilian vascular trauma remains predominantly penetrating in many regions, while **iatrogenic vascular injury** (arterial access, endovascular and cardiac procedures) is increasingly common. [@branco2014]
- Mortality is highest in **non-compressible torso hemorrhage** and major junctional injuries; outcomes depend on rapid hemorrhage control and access to definitive repair. [@rutherford2018]

**Modern management paradigm (endovascular trauma management (EVTM) and damage control)**

- Contemporary care integrates **open, endovascular, and hybrid** options, aiming for rapid hemorrhage control with staged definitive repair ('damage control vascular surgery'). [@trauma2016]
- Endovascular adjuncts (embolization, balloon occlusion, stent-grafts) and hybrid workflows are now central to many high-acuity scenarios. See [[EVTM|EndoVascular Trauma Management (EVTM)]]. [@trauma2016]
- For thoracic aortic trauma and selected junctional injuries, outcomes have improved with **endovascular-first strategies** in appropriate anatomy and physiology. [@riambau2017][@esvs2025]