Major visceral vascular injury after acupuncture is a rare but serious complication. We recently treated two patients with an inferior vena cava or an abdominal aorta injury caused by acupuncture. Although both patients underwent successful surgical repair, the highly invasive nature of the operations led to complications, including infection and chyle leakage. Vascular surgeons should be aware that acupuncture can cause serious damage to the vena cava or aorta due to direct injury or subsequent infection.