Effective diagnosis and management of associated vascular injuries is imperative to minimize morbidity after extremity trauma. An algorithm is presented for the diagnostic evaluation of patients with extremity trauma. The value of physical examination and Doppler indices in identifying occult injuries is discussed. The natural history of certain occult, nonocclusive injuries suggests that nonoperative management may be considered. The intraoperative management of major arterial and venous injuries, including current controversies, is addressed also.