Introduction: Armed conflict has driven major advances in vascular surgery, transforming uncontrolled haemorrhage from a fatal event into a survivable injury. From ligation and amputation in World War I to systematic repair strategies in the Vietnam War, conflict has shaped both techniques and systems of care. Registry and military data demonstrate substantial reductions in mortality and limb loss with the evolution of vascular repair, organised evacuation, and damage control principles. Methodology: This study synthesises historical and contemporary evidence from major conflicts. Insights are drawn from modern combat casualty datasets, including reports from the Russo-Ukrainian War, alongside key studies on temporary intravascular shunting, damage control surgery, and haemostatic resuscitation. Vascular and trauma literature informs analysis of changing injury patterns and treatment strategies. Results: Modern warfare involves high-energy blast and fragmentation injuries causing complex, multi-level vascular trauma with severe soft tissue damage. Survival has improved with early haemorrhage control, forward surgical teams, and flexible evacuation systems. The use of whole blood transfusion, “walking blood banks,” and temporary vascular shunts is associated with improved limb salvage and reduced mortality. Emerging technologies such as bioengineered grafts and infection-resistant conduits show promise, though long-term outcomes remain under evaluation. Conclusion: The relationship between war and vascular innovation is cyclical. Advances in haemorrhage control, resuscitation, and reconstruction improve survival but respond to increasingly destructive injuries. As modern conflicts strain evacuation systems and increase mass casualties, there is a need for portable, resilient, and integrated vascular care. Addressing these challenges requires both technical progress and reflection on the human cost driving innovation.