The arterial trauma occurs in different scenarios such as politrauma, stab and gunshot wounds and iatrogenic. Surgical vessels ligation was the common method of bleeding control in World War II with an amputation rate of 50%. Surgical vessels reconstruction is currently considered the first option; however, this is no longer necessary in many cases. There are different mechanisms of arterial injury ranging between intimal flap and spasm to AV fistula and complete transection with or without arterial destruction. The amount and speed of bleeding after arterial trauma are the main factors to decide if an invasive treatment is necessary and when and how to treat it. Embolisation is a smarter, less invasive and safer method of ligation with similar results than surgery in terms of bleeding control. Vessel reconstruction is now also possible with endovascular devices. In general we will choose embolisation for small and peripheral arteries and vessel reconstruction with stent grafts for injuries in central and large arteries. In pseudoaneurysm and AV fistula there is no active bleeding and endovascular treatment can be done either by embolisation or stent graft. Coils are widespread as embolisation material but sometimes do not achieve a complete bleeding control mainly if patients suffer coagulopathy. Liquid embolics like cyanoacrylate and onix are less used but have some advantages over the coils. Many aortic injuries can be treated with stent graft and with less morbidity and mortality than surgery. The follow-up is mainly clinic with Doppler ultrasound and CTA as ancillary tools.