Thoracic trauma remains a source of high morbidity and mortality, occurring in approximately 25% of trauma victims. Injury to the thoracic aorta and arch vessels occurs in 4% of thoracic trauma (Lim JY, et al. Minerva Chir. 2013;68:251–62). Prompt diagnosis is critical, and a high index of suspicion is typically required, as presenting signs and symptoms can often be nonspecific. Management strategies depend on the degree of injury and the stability of the patient. Minor injuries in stable patients can often be managed nonoperatively, while major injuries with hemodynamic instability can require complex open or endovascular repair. This chapter describes the pertinent anatomy, diagnosis, and treatment of injuries to the thoracic aorta and arch vessels.