Inferior vena-cava (IVC) injuries are uncommon but mortality is high, despite the improved organization and technical skills. The most important prognostic factors are the grade of hemorragic shock, the anatomical level of caval injury and the associated vascular lesions. Supra and retro-hepatic lacerations have the worst prognosis and their management is more difficult, as it’s sometimes necessary performing complicated and high mortality related procedures, such as atrio-caval shunt and total vascular occlusion. Still controversial is the management of retroperitoneal hematomas due to suspect caval laceration. Non-operative treatment can represent a good option in non-pulsatile hematomas, while packing can be performed in case of very poor hemodynamic condition, delaying definitive surgical treatment. Vascular repair by primary venorrhaphy can usually be performed, sometimes a patch is to be used. Infrarenal cava ligation can be an acceptable, significant complication free option. Caval thrombosis and pulmonary embolism represent the most important but uncommon complications. US and CT-scan are used in non-invasive follow-up of injuried IVC but timing is still controversial.