Injury to major blood vessels has been the subject of numerous reports, particularly during and after periods of international conflict. The papers of De Bakey and Simeone1 and Rose and associates,2 following World War II, and the report of Jahnke and Seeley3 on vascular injuries in the Korean War are representative. Previously reported major vessel injuries associated with elective surgical procedures include the aorta and iliac vessels,4-8 the inferior vena cava,9-11 and the superior vena cava.12 The late complication of arteriovenous fistula following unrecognized operative injury has been noted by Elkin13,14 and Glass and Ilgenfritz.15 The present report represents our combined experience in the management of 11 cases of major vascular injury arising during the course of elective operative procedures. The methods employed varied from ligation of the injured vessel to graft reconstruction. In two instances major arterial flow was reestablished by