Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. Initial management of these patients should be according to the guidelines of the advanced trauma life support group (ATLS). Patients with a suspected TAR are preferably managed by controlled hypotension. TAR can be diagnosed by spiral CT angiography, additional angiography is not needed. Although results from conventional surgery have improved over the years, results from endovascular grafting are better with reduced mortality and paraplegia rates. Acute open surgery has become the second choice and patients are preferably managed by endovascular treatment. The endovascular graft can be placed with a minimal invasive procedure and delay in treatment because of accompanying injuries is avoided. Patients with a TAR treated by an endovascular graft should be kept under surveillance. For optimal patient care level I trauma centers should have thoracic endovascular grafts available for direct use.