Trauma is an unusual cause of fistula formation between the aorta and the inferior vena cava. Two cases of traumatic aorto-caval fistula treated at the New Jersey Medical School affiliated hospitals are presented and the literature on traumatic aorto-caval fistula reviewed. We found 14 previously reported cases. Delayed repair was performed in 12 (86%). Delays ranged from 5 days to 12 years postinjury. Cardiac decompensation, judged either clinically or by cardiomegaly evident on chest X-ray, was present in 75% of the patients undergoing delayed repair. The techniques available for repair and the criteria for utilizing delayed repair are discussed. In young, previously healthy patients, usually with smaller fistulae, we conclude that delayed repair can be used.