Patients with traumatic transection of the thoracic aorta are now more frequently seen in the Emergency Department due to an increase in the number of high-speed motor vehicle collisions and improvements in the Emergency Medical System. Although transection of the aorta is usually fatal, patients who survive long enough to undergo surgery have a good prognosis. In this report, two cases of complete thoracic aortic transection are described. Both patients were involved in motor vehicle collisions. The first, a 52-year-old woman, underwent emergent angiography and aortic repair within 3 hours of admission. The second patient, a 39-year-old man, underwent hepatic lobectomy immediately after admission, and aortic repair the following day. In the setting of complete thoracic aortic transection with multisystem trauma, a flexible strategy is probably the most important measure impacting survival.