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Published Citation: J Trauma. Injuries to peripheral arteries are seen most commonly in the military setting or in trauma centers with a high volume of penetrating injuries. Most peripheral arterial injuries occur in the femoral and popliteal vessels of the lower extremity. The issues of how to diagnose, treat, and manage penetrating lower extremity arterial trauma were first addressed by the Eastern Association for the Surgery of Trauma EAST in the practice management guidelines on this topic established in During the past 10 years, there have been advances in the treatment of penetrating lower extremity arterial trauma. As a result, the Practice Management Guidelines Committee decided to develop updated guidelines for this topic. There are several issues identified as relevant to this practice management guideline update. Specific areas of focus included the prehospital management of patients with hemorrhage from lower extremity penetrating trauma, diagnostic evaluation, choice of radiologic imaging, and the use of intravascular shunts as an adjunct to operative management.