Vascular complications may occur in any clinical scenario and obtaining a satisfactory outcome sometimes taxes even the most experienced surgeons. The impact of intra-operative vascular complications may be mitigated through thoughtful preoperative preparation and knowledge of vascular reconstructive techniques. Unexpected intra-operative bleeding is best managed using the time-tested approach of the trauma surgeon, which is access, exposure, control, and repair. Even in the postoperative state, vascular issues may arise.