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The blunt injury of the thoracic aorta constitutes one of the most severe chapter of traumatology. Open and transmural aortic injury leads to death on site, but its blunt trauma provides chance for survival if expeditious transport, diagnostic workup and proper selection of treatment are given. The blunt trauma of the aorta usually is a part of multiple injuries which determines the final outcome significantly. To select among acute, subacute interventions and conservative treatment options needs great experience following personalized algorithm. The wide variety of the clinical picture makes difficult to formulate an individualized clear guideline - so we think it is important to summarise own experiences and overview related literature.