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There is a well-established body of literature in the management of vascular injuries that underscores the benign natural history of minor so-called occult arterial injuries. The standard approach for the management of the proximity extremity wound has evolved into one of watchful waiting. We present a case of an occult arterial injury that declared itself with an acute arterial bleed after about 30 hours of observation indicating that caution and preparation remain critical in the management of these patients.doi:10.31487/j.scr.2019.04.08 fatcat:guvjbf266nfene7kas7me5jfzy