The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions.