Vena caval injuries are relatively rare and are associated with a high mortality before the patient arrives at a medical facility and even after initial resuscitation and operative intervention. Survival is directly related to (1) the location of the injury, (2) the amount of active bleeding, and (3) the type and number of associated injuries. To achieve maximum survival in patients with serve injury, rapid transportation to an emergency room is necessary. Resuscitation must then be aggressive, with rapid transferral to the operating room, and the surgeon must know the various techniques available for repair.