Haemorrhage has historically been the leading cause of early mortality following trauma. Contemporary methods of vascular control are often framed as post-medieval innovations, with earlier practice frequently characterised as relying predominantly on cautery and compression. However, the literature of Byzantine physician-surgeons demonstrates a more developed operative approach to haemostasis that refined earlier traditions and informed later surgical practice. Analysis of translated passages from Paul of Aegina’s Epitome of Medicine (7th century CE), alongside the writings of Aëtius of Amida, shows clinical differentiation between brighter, pulsatile arterial bleeding and slower, darker venous haemorrhage. Both authors describe mechanical control using hooks to isolate bleeding vessels, facilitating targeted haemorrhage control. Paul provides step-by-step operative descriptions for the exposure of major vessels and application of ligatures proximal to the site of injury. He advocates ligation at the vessel root prior to division as the safest approach, refining earlier recommendations by the Roman physician Galen, who described ligation or transection as separate, non-sequential strategies. Unlike earlier references to vessel control, these Byzantine texts situate haemostasis within the context of traumatic injury. They emphasise vessel identification and proximal control. These principles informed later surgical texts, including Kitab al-Tasrif written by 10th century Andalusian surgeon Albucasis. The writings of Byzantine physician-surgeons demonstrate an empirical understanding of haemorrhage and operative strategy that aligns with modern principles of proximal vascular control. Their work represents a critical and often under-recognised link between ancient surgical knowledge and modern trauma practice, highlighting the enduring importance of targeted haemostasis in the management of traumatic bleeding.