Interventional radiology is in a unique position to provide both expert image interpretation and treatment for vascular emergencies. With a general shift toward becoming a more clinical specialty, many interventional radiologists appreciate being contacted early in a patient’s care pathway. The authors have witnessed many instances where interventional radiology was contacted late in a patient’s management, which can compromise the outcome. With varied provision of interventional radiology on-call services globally, “when to call the interventional radiologist” is heavily dependent upon an individual institution’s logistical setup. Another factor to consider is that many on-call interventional radiology services are based around a team that is “off-site” and requires advanced notice before a case can be initiated. Again, this further emphasizes the importance of contacting interventional radiology early in a patient’s care pathway. In the cases below, we have sought to highlight specific conditions where interventional radiology can assist in providing both expert vascular imaging interpretation and management. The vascular emergencies that have been highlighted include ruptured abdominal aortic aneurysm, aortic dissection, liver/kidney/spleen/pelvic trauma, acute limb ischemia, hemoptysis, gastrointestinal bleeding, and postpartum hemorrhage. This revised chapter provides an update on the use of IR-guided treatment of pulmonary embolism, which is an area of rapidly evolving clinical practice.