Operative risk for surgical treatment of traumatic isthmic rupture of aorta is high either for the difficult surgical technique, either for multiorgan involvement from the traumatic accident. Diagnostic and therapeutic approach in these patients most often must be carried out by many specialists working in team. From 1992 to 1997, 15 patients have been operated at the Department of Cardiac surgery of the Azienda Ospedaliera di Parma for acute traumatic transection of upper descending aorta. All patients had multiple lesions. Aortography is still the " golden standard " for quick and easy diagnosis but transesophageal echocardiography is becoming a valuable and precise diagnostic tool. The key for therapeutic success is probably the continuos evaluation of the patients with careful rethinking of therapeutic opportunities and priorities.