Historically, epidemiology, diagnosis, and management of venous trauma have not been well understood. Venous injuries often have subtle presentations, unclear consequences, and debatable treatment options. Many venous injuries are asymptomatic and are diagnosed only during surgical exploration for other injuries. The obvious venous injury is the one found during surgical exploration of an arterial trauma. Isolated venous injuries are difficult to diagnose and often only discovered if massive swelling or life-threatening hemorrhage occurs. Once discovered, the question is how to treat: ligation or repair. The answer is the prudent use of both methods. For patients at the brink of hemodynamic collapse, ligation is the best choice. For stable patients, an effort should be made to reestablish venous outflow. Definitive repair in unstable patients should not attempted, instead temporary solutions should be used that will allow the patient to leave the operating room quickly and began correction of hypothermia, acidosis, and coagulopathy.