Major vascular trauma is defined as injuries to blood vessels (arteries and veins) greater than 4 mm (1). Vascular trauma can occur for a variety of reasons: penetrating and blast injury in conflict zones, terrorist attacks, blunt trauma from traffic accidents or falls from a height, and iatrogenic trauma from modern invasive medicine. These injuries are often associated with significant head, soft tissue, and/or skeletal injuries. Massive bleeding after major trauma is a leading cause of preventable death. Blunt or penetrating trauma, including iatrogenic trauma, can result in end-organ damage due to rapid blood loss or catastrophic hypoperfusion.