The accepted treatment for post-traumatic arteriovenous fistulas has been to permit development of collateral circulation and then perform either vascular repair, excision of the fistula, or quadruple ligation. At the Los Angeles County-University of Southern California Medical Center, a policy of early surgical repair was developed about nine years ago. Twenty-seven patients with fistulas involving major arteries of the upper and lower extremities, neck, and branches of the aortic arch have been treated. Thirteen patients were operated upon within 24 hours of injury, seven patients between one and four days, and seven patients between 11 and 26 days. The results were excellent in 23 patients, good in two, poor in one, and one patient died. Early surgical repair of acute post-traumatic arteriovenous fistulas is recommended.