Background and Aims Although the incidence of high-voltage electrical burns is very low, its potential damage to the muscle, nerve and blood vessel is more insidious than that of flame burns. The limb-threatening ischemia and delayed rupture/bleeding will lead to loss of limb function, disability and even death. There is no definite incidence number for limb vascular injuries after high-voltage electrical burns, nor is there any recommendation of diagnosis and treatment guidelines, and the treatment schemes of each center are different. As a national burn rescue center, our hospital treats a large number of burn patients every year, including high-voltage electrical burn patients with vascular injuries. This paper summarizes the diagnosis and treatment schemes of patients with high-voltage electrical burn wounds combined with vascular injuries treated in our hospital in recent 10 years, trying to analyze the differences between this category of patients and patients with traumatic arterial injuries, and extracting the diagnosis and treatment characteristics of these patients, so as to provide evidence support for future clinical work.Methods A total of 94 patients with limb vascular injuries caused by high-voltage electrical burns treated in our center from January 2010 to January 2020 were reviewed. The vascular repair methods included direct local repair, autologous vascular reconstruction and prosthetic vascular reconstruction. The incidence rates of postoperative complications such as thrombosis, delayed rupture/bleeding, infection, amputation were analyzed, and the differences of the data were compared.Results Of the 94 patients, 83 cases were males and 11 cases were females, with an average age of (30.4±20.1) years. Seven patients underwent amputation due to serious limb damage at initial admission. Eighty-seven patients received vascular repair that included local repair in 29 cases, autologous vascular reconstruction in 53 cases, and prosthetic vascular reconstruction in 5 cases. The technical success rate was 100%. Among patients undergoing local repair, 3 cases developed thrombosis and 2 cases developed pseudoaneurysm within 2 weeks after operation, and all of them underwent repeated operation of autologous revascularization. Among patients receiving autologous vascular reconstruction, thrombosis occurred in 7 cases within 2 weeks after operation, and their blood supply were improved after incision and thrombectomy, delayed rupture/bleeding occurred in 4 cases, of whom, incision, hemostasis and second reconstruction were performed in one case, covered stent was implanted in 3 cases, and limb amputation was performed in 3 cases due to postoperative infection or severe soft tissue necrosis. Among patients with prosthetic vascular reconstruction, one case had thrombosis within 2 weeks after operation, which was resolved by blood supply restoration after incision and thrombectomy, and one case had delayed rupture/massive hemorrhage, and then underwent endovascular covered stent implantation. Follow-up was obtained in 75 patients for 3-6 months, and the vascular patency rate was 89.3% (67/75).Conclusion The vascular injuries after high-voltage electrical burns are far beyond the visible damage, which is different from the injuries associated with general trauma. Before vascular reconstruction, the condition of injured vessels and surrounding tissues should be fully evaluated. On the premise of adequate debridement, both autologous vessels and prosthetic grafts can be satisfactory reconstruction materials; The vascular injuries caused by high-voltage electrical burns will progress over time. The occurrence of thrombosis and delayed rupture/bleeding should be vigilant. Once delayed rupture occurs, incision for hemostasis and reconstruction or endovascular interventional treatment should be performed in time, so as to preserve the affected limb.