In the last ten years, 22 patients with transection of the descending thoracic aorta were seen at the Ben Taub General Hospital. Five patients with massive left hemothorax died shortly after admission. Among 17 patients in whom proximal and distal control could be achieved, three died in the operating room; three died within 30 days of operation, and one patient died of sepsis more than 1 year postinjury: ten patients are longterm survivors. Partial pump bypass was utilized in six patients, and in one a heparinized shunt was used intraoperatively. Dacron tube grafts were used in 12 cases, and primary repair was accomplished in three. One patient was paraplegic on admission, and two others in whom this was not established before operation were found to have this complication postoperatively. One patient with an infected false aneurysm 1 year after operation underwent resection of the distal aortic arch and Dacron graft with extensive extravascular bypass procedures. Patients with transection of the descending thoracic aorta die if proximal control is not achieved before rupture of the hematoma. Successful repair of this injury requires aggressive diagnostic and surgical management.