Iatrogenic injury of the thoracic aorta is a rare but potentially fatal complication, most frequently encountered during spinal, cardiothoracic, or esophageal surgery. Its incidence ranges from 0.01% to 1%, yet the associated mortality remains high, reaching up to 65%. Early recognition is essential, as clinical presentation may be subtle or delayed. Mechanisms include direct vessel laceration, erosion from surgical equipment, or iatrogenic catheter-related trauma. Multimodal imaging, particularly CT angiography, plays a crucial role in diagnosis and management planning. Treatment strategies depend on the site and extent of the lesion and may include open surgical repair, thoracic endovascular aortic repair (TEVAR) or hybrid procedures. Endovascular management has become the preferred approach due to lower morbidity and excellent technical success, even in emergent settings. A high index of suspicion, multidisciplinary coordination, and prompt vascular surgical involvement are key to optimising outcomes.