Purpose: Central abdominal venous trauma is rare and poorly standardised. We describe phenotypes, management and outcomes after inferior vena cava (IVC) and common iliac vein (CIV) injury at a Level 1 trauma centre. Methodology: IVC/CIV injuries from 2015-2024 were identified using ICD codes, trauma registry and theatre databases. Data included mechanism, associated injuries, physiology, Injury Severity Score (ISS), massive transfusion protocol (MTP), management, discharge antithrombotic strategy, complications and mortality. Fisher’s exact and Mann-Whitney U tests explored group differences. Results: Twenty patients were included: 14 blunt and 6 penetrating/iatrogenic; median age 39 years; 15 male. Injuries involved IVC in 18 and CIV in 3. Twelve underwent intervention (11 open, 1 endovascular) and 8 were managed conservatively. Intervention patients had higher lactate than conservative patients (5.0 vs 2.35 mmol/L, p=0.01); median ISS was 19 vs 26.5. Intervention patients were diagnosed intraoperatively in 11/12 with MTP activation in 11/12; all conservative patients were CT-diagnosed with no MTP activation (p<0.001). Hollow viscus/mesenteric injury occurred in 7/12 intervention patients and 0/8 conservative patients (p=0.015). In-hospital mortality was 4/6 after blunt intervention, 1/6 after penetrating/iatrogenic intervention and 0/8 after conservative management. Among 15 survivors, discharge strategy was none in 8, aspirin in 3 and therapeutic anticoagulation in 4. No venous thromboembolism (VTE) or venous injury-related complication was documented during median 44-month survivor follow-up. Conclusion: Blunt polytrauma requiring intervention carried high mortality, while CT-detected stable venous injury was managed non-operatively without VTE despite variable antithrombotic practice. Multicentre data, standardised reporting, surveillance imaging and antithrombotic pathways are needed.