Background: Vascular trauma is frequently immediately life-threatening and occurs in the setting of complex multisystem injury, where delays to definitive haemorrhage control or revascularisation markedly worsen outcomes, and therefore inter-hospital transfer is not feasible, underscoring the importance of an embedded vascular surgery service within a major trauma centre. This study examines the volume, acuity, and procedural scope of vascular trauma managed at Alfred Health, Victoria’s highest-level trauma centre. Methods: All vascular surgical procedures performed at Alfred Health between 2010 and 2025 were retrospectively analysed. Trauma-related operations were identified and classified as non-iatrogenic or iatrogenic. Demographics, physiological status, anatomical distribution, and operative technique were examined. Results: Over the 15-year study period, 698 vascular operations were performed for trauma indications with non-iatrogenic trauma accounting for 358. Patients were predominantly male (78.8%) and physiologically high-risk (64.5% ASA III–V). Vascular injury involved a broad anatomical distribution, including lower limb vasculature (12.0%), thoracic and thoracoabdominal aorta (11.3%), popliteal and femoral vessels (10.6%), subclavian and axillary vessels (8.7%), brachial and upper limb arteries (7.6%), and cervical vessels (6.5%). Operative management was heterogeneous, encompassing open repair (local repair 17.6%, ligation 8.7%, interposition grafting 7.0%, bypass 12.7%), endovascular intervention (stents and stent grafts 22.1%), hybrid procedures, fasciotomy (2.2%), and major amputation (3.1%). Conclusions: This 15-year experience demonstrates that vascular trauma represents a sustained, high-acuity workload requiring immediate access to comprehensive open, endovascular, and hybrid surgical capability. We demonstrate that an embedded vascular surgery service is indispensable for definitive trauma care and cannot be replaced by transfer-dependent models.