Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. Non-invasive examinations such as CT and transesophageal echocardiography aid greatly in making the diagnosis. Urgent conventional repair is still considered the gold standard technique for cases of isolated rupture, or rupture without severe concomitant lesion where aortic clamping and heparinization will not impair post-operative outcomes. Urgent endovascular repair has been shown to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple trauma instead of delayed classical surgical repair after stabilization. Long-term results of endovascular repair need to be assessed before enlarging the indications of this technique in the emergency setting.