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Lesions of the aorta are rather common and include the aneurysmal, arteriosclerotic, fistula, and dissection types. Less common are the thrombotic, especially the acute occlusive episodes, lesions of the aorta. Sudden severe painful symptoms usually develop with the formation of an acute intraluminal aortic thrombosis. When the lesion is only partial and productive of lesser symptoms, treatment may be conservative utilizing anticoagulant therapy. When the thrombosis is sudden, totally obstructing, and productive of severe symptoms or morbid loss of function, emergent diagnosis and therapy will follow. Such lesions may result from embolic, acute dissection, malignancy, blood flow abnormalities, as well as iatrogenic causes including invasive techniques or stirrup positioning of extremities for surgery. Prognosis depends on the severity of the obstructive lesion, the underlying cause, the patient condition on presentation and the response to therapy.