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Acute aortic dissection is without any doubt the most feared and life threatening aortic emergency. It is associated with a dreadful mortality rate and an immediate and accurate diagnosis without delay followed by adequate treatment is mandatory. It is important to make a distinction between acute type A, uncomplicated and complicated type B. Acute type A dissection generally requires urgent surgery, complicated type B dissections are treated with endovascular techniques; there is ongoing debate whether uncomplicated type B dissections should also be treated by endografts in its early phase. Surgical repair of acute type A dissection consists of the replacement of the intrapericardial ascending aorta with varying segments of the arch and/or aortic root. The endovascular techniques with stentgrafts deployed into the proximal descending aorta in type B dissections have revolutionized the surgical therapy and the patient�s immediate and medium-term survival. For chronic postdissection aneurysms open surgery still remains the golden standard. Acute traumatic aortic isthmus ruptures are similar life threatening conditions and account for one of the main causes of death at the time of traumatic accidents. In these situations also stentgrafts have changed the outcome of these severe and multiple traumatic patients.