The outcome from a given major vascular trauma (blunt or penetrating) for the patient and the target organ / limb is very variable and depends on many different factors. It is my experience that Vascular Reconstruction (as opposed to simple ligation) is needed in only a minority of cases. When a patient sustains a major vascular injury, the following are possible outcomes: 1. Patient dies immediately or at site of injury (common); 2. Patient does not reach hospital alive (common); 3. Patient reaches hospital alive, but the limb is already dead (common); 4. Patient reaches hospital alive and the limb is not critically ischemic – urgent or delayed reconstruction probably not needed (common); 5. Patient reaches hospital alive and the limb is alive but critically ischemic – urgent reconstruction (uncommon). Management sequence consists of: a. Hemorrhage control (pressure, tourniquet etc) b. Manage other life threatening problems (airway, chest etc) c. Is the limb salvageable? Is the limb critically ischemic? Is vascular repair possible?, advisable? d. Decide on reconstruct or ligate; e. Fasciotomy Factors affecting the need for reconstruction: 1. Artery injured: Some arteries ~never need reconstruction (eg isolated radial, subclavian), some always (eg popliteal, CFA) & some dependent on other factors. 2. Are the collaterals damaged? What is the size & complexity of the wound? 3. Is the limb critically ischemic? 4. General state of the patient & hospital (multitrauma – mass casualty) Reconstruction options: a. Primary repair of hole or partial division artery (occasional) b. End – End repair (uncommon) c. Long Saphenous Vein interposition graft (workhorse) d. LSV bypass e. Temporary shunt for delayed repair