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Thoracic aortic injuries are fatal with less than 50% patients surviving beyond 24 hours even after reaching the hospital if approach is delayed. Rapid transportation, adequate resuscitation, prompt radiological diagnosis, and urgent repair significantly improves outcomes. Even after a food repair, complications such as spinal cord ischemia causing paraplegia and acute lung injury significantly increase the morbidity. Thoracic endovascular repair may appear to be superior to open repair, but its long-term results and efficacy are not well established. We present our experience with open repair in managing this challenging acute emergency and certain measures to avert common but grievous complications.