The records of 70 patients with vena caval injuries who were treated from 1970 through 1983 were reviewed to define factors determining patient survival. Fifty-two percent of patients survived, with the highest mortality in patients with blunt or shotgun injuries. The primary determinants of survival were the mechanism and type of injury, the initial BP, the hemodynamic response to fluid resuscitation, the location of the vena caval injury, the presence of multiple other vascular and solid organ injuries.