Aortic dissections after deceleration traumas are mainly located in the region of the proximal descending thoracic aorta. Less common are brachiocephalic trunk ruptures, which are not automatically amenable to an endovascular treatment. We present a poly-traumatized patient with an intimal tear at the origin of the brachiocephalic tunk with intramural haematoma extension to the ascending aorta. In addition, the left common carotid artery originated from the proximal brachiocephalic trunk, forming a 'bovine arch'. Aortic arch and supra-aortic arteries were successfully replaced. The case demonstrates the importance of an individualized treatment in complex intrathoracic vascular injuries in poly-traumatized patients, including a careful risk assessment.
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