Injuries to major vessels during combat have been associated with high mortality and morbidity, despite optimal triage and management. Eighty-two vena caval injuries from the Vietnam Vascular Registry (VVR) series have been studied. The nature of the wounding agents, location of wounds, and associated injuries have been documented and are contrasted with those of recent civilian series. Seventy-eight abdominal vena caval injuries were associated with mortality in 18 (23%), in whom 56 underwent repair of the injury and 15 had ligation of the inferior vena cava. This is the largest series reported of war-related vena caval injuries, and therapeutic alternatives and general recommendations derived from this review are presented.