Six patients underwent emergency surgery for descending aortic injury following blunt trauma to the chest; three survived. Associated injury was a critical factor in two of the three patients who died. In the third patient, prolonged ischemia of the lower half of the body due to total aortic distraction with a distal aortic flap produced irreversible changes that were manifest during reperfusion of the body. Angiography is recommended if the patient's condition is stable and other injuries demanding immediate surgical attention are not present. If, however, there are other serious injuries and adequate distal perfusion, then these other injuries should be corrected before aortic repair is undertaken.