One day, this comprehensive, up to date, and carefully refreshed (see Preface) account of the management of vascular trauma in the second decade of the 21st century will move from the shelves of volumes that constitute the medical school curricula around the world to the quieter library stacks of medical history. The emerging hot topics explored on its pages will have been resolved and incorporated into the clinical mainstream. The innovations and new assessments described in each of its

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... s will have become common practice, and the evolving systems will have been consolidated and implemented as standard. The calls for new management strategies to fill the gaps in current capabilities will have been answered. Vascular surgery, the youngest of the 10 surgical specialties, will have grown into all its potential. Rich's Vascular Trauma, in this current and three previous editions, provides the textual infrastructure that has enabled this remarkable disciplinary growth. When, eventually, it is replaced by successor volumes, its value will be transformed. Its contents will assume a different responsibility: that of providing a definitive historical record of the creation of vascular surgery in the modern era. Each revised edition contributes to the challenging task of focused and sustained tracking of an intricate, highly technical surgical specialty that has developed at extraordinary speed. Additionally, this fourth edition contributes a truly international dimension, drawing on testimony and evidence from vascular specialists with regional and national specificities in their provision that has contributed to the global development of the discipline and its community of practice. The features that make this work essential for vascular specialists also secure its particular interest for medical historians. It pays respectful attention to the practices of the past that would eventually coalesce into the discipline of vascular surgery and the formal management of vascular injury. The historical review picks up the first signs of the integration of military and civilian medical practice in vascular repair to show that it is a fascinating constant of vascular surgery that alliances forged by military medics in times of war were consolidated in peace. Despite the unprecedented scale and pace of military casualty, lessons from field surgery were learned, transmitted, and applied consistently in civilian practice. Within the medical sector, it is rare to see progress maintained and stabilized across periods of transition. A key consequence of this extraordinary success is that both clinician and patient expectations of survivability were revised significantly, and remain undiminished. This work provides evidence and exemplar of disciplinary progress and good historical practice, as well as a crucial reminder that there are responsibilities to be respected when the stakes of survival are renegotiated. One element will never change no matter the century or the mechanism of vascular injury. Survivors, whether unexpected or anticipated, will seek to understand the process by which their lives were secured. This is a useful dimension of the work that we suggest might receive additional consideration. Rich's Vascular Trauma is a resource that enables professional development, historical reflection, and, above all, answers to that most important and complicated question asked by the patient from their life beyond survival: "what happened to me?"