The study of blood vessel injury has largely focused on diagnosis, treatment, and the outcome of treatment. Although the epidemiology of trauma in general has been extensively studied and reported, the specific epidemiology of vascular injury has not. This report includes a general discussion of the incidence of and risk factors associated with injury to blood vessels. Vascular injury epidemiology has been studied in three different settings: military conflicts, large urban centers, and to a lesser extent, in rural areas. There has been an increase in the incidence of vascular injury in the United States over the past four decades that has paralleled the increase in assault with firearms, motor vehicle crashes, and invasive medical procedures. Mortality and the utilization of medical resources is higher among patients with vascular injury than among trauma patients without blood vessel injuries. There are well-documented differences in the demographics of blood vessel injury in urban versus rural settings. The mechanisms of injury (penetrating, blunt, iatrogenic) are associated with characteristic anatomic patterns of vascular and other organ system injury.