Injuries to the great vessels of the torso are more commonly seen and managed in busy urban trauma centers. This same injury complex is rarely seen in military conflicts, likely due to the high kinetic energy wounding mechanisms seen in this setting. While most of the great advancements in trauma surgery over the past century have generally resulted from our wartime experience, civilian centers have contributed greatly to the understanding and management of torso vascular injuries. The presentation and management of injuries to the great vessels of the torso from major penetrating and blunt trauma are reviewed.