The increasing frequency and severity of urban violence and vehicular injuries have brought with them a rise in the number of complex vascular injuries. To examine the cause, incidence, management, and outcome of this problem, we created a vascular trauma registry which includes all such cases treated at a Level I metropolitan trauma center over the past nine years. This constitutes a summary report of that registry. During the period 1979-1988, 411 patients (355 men, 56 women) with 478 vascular injuries were treated. There were 18 deaths (4%). Primary diagnosis was grouped by anatomic region: (1) head and neck vessels, 62 (15%); (2) thoracic, 39 (10%); (3) abdominal and pelvic, 63 (15%); (4) upper extremity, 161 (39%); and (5) lower extremity, 86 (21%). Surgery was required in 241 cases (60%). Operative techniques consisted of ligation or resection in 26 (12%) and direct repair in 212 (88%). Associated procedures included: (1) laparotomy (n = 83); (2) craniotomy (n = 4); (3) thoracotomy (n = 49); (4) orthopedic procedures (n = 118); and (5) peripheral neurological repair (n = 70). Mechanisms of injury were: (1) gunshot wounds (32%); (2) stab wounds (45%); (3) motor vehicle accidents (18%); (4) fall (3%); and (5) other mechanisms (2%). We conclude: (1) vascular injuries were found frequently in the severely injured patient; (2) multiple vascular repairs were required in a significant proportion of these patients; and (3) outcome is dependent more upon associated trauma than on the vascular injuries themselves.