Over the last 2 decades, several advances in the care of patients with vascular injuries, such as better understanding of shock and resuscitation, interventional angiography for diagnosis and treatment, consolidation of the principles of abbreviated surgery and planned reoperation, and nonoperative management of selected vascular injuries has resulted in an increase in limb salvage. The management of femoral vessel injuries seems to be straightforward in most situations; however, some unit presentations may challenge even the most experienced trauma surgeon. This article describes the options in the surgical management of these injuries. Special attention is dedicated to combined orthopedic and vascular injuries, the use of temporary arterial shunts, the potential advantages and disadvantages of prosthetic materials, and the use of fasciotomies.