Background and Aims The aortic injury caused by various high-energy trauma such as car accidents and falls from great heights are often insidious and difficult to determine, which make the condition more complex. Repair of the injured aorta is necessary before surgical intervention for severe trauma. At present, thoracic endovascular aortic repair (TEVAR) has been widely conducted because of its advantage of minimal invasiveness and quick recovery, which provides great help to avoid delaying the specialized treatment of multiple injuries. This study was performed to investigate treatment strategies for traumatic aortic injury (TAI) through analyzing its pathological features and comparing the efficacy of TEVAR for TAI and the Stanford type B aortic dissection.Methods The data of 20 TAI patients (TAI group) undergoing TEVAR during November 2015 to December 2020, and 50 patients with non-traumatic Stanford B aortic dissection (non-TAI group) undergoing TEVAR during the same period in Xiangya Hospital of Central South University were retrospectively analyzed. The clinical variables between the two groups of patients were compared.Results No significant difference was identified in sex and age between the two groups (both P>0.05), but the proportion of patients with hypertension was lower in TAI group than that in non-TAI group (40.0% vs. 74.0%, P<0.05). The proportions of cases with localized tear and the primary tear at the aortic isthmus were higher in TAI group than those in non-TAI group (80.0% vs. 34.0%; 70.0% vs. 24.0%, both P<0.05), while the proportions of cases with the tear number ≥2, the involvement of the supra-arch branches, and the distance from the primary tear to the left subclavian artery (LSA) <15 mm were lower in TAI group than those in non-TAI group (30.0% vs. 78.0%; 10.0% vs. 52.0%; 40.0% vs. 72.0%, all P<0.05). In addition, the oversize of the stent graft was larger in TAI group than that in non-TAI group (P<0.05). The length of hospital stay was significantly longer in TAI group than that in the non-TAI group (16.80 d vs. 11.20 d, P<0.05), and the incidence of postoperative complications was higher in TAI group than that in the non-TAI group (20.0% vs. 4.0%, P<0.05). The follow-up results showed that there were no statistical differences in terms of complication rates and survival time between the two groups (both P>0.05), but the rates of volume changes in the false lumen and thrombus absorption were higher in TAI group than those in non-TAI group (95.0% vs. 72.0%; 90.0% vs. 58.0%， both P<0.05).Conclusion TAI is in urgent, critical and complex situations due to multiple injuries resulting from different causes, so the vascular repair should be performed individually based on the injury types, including the choice of surgical timing, the length of stents, oversize, the judgment of the landing zone and preservation or revascularization of the LSA. After TEVAR, the rates of volume changes in the false lumen and thrombus absorption were significantly higher in TAI patients than those in non-TAI patients, which reflects the appropriate remodeling of the aorta in the mid-term of the TAI, and thereby demonstrates the favorable efficacy of TEVAR in the treatment of TAI. However, its long-term efficacy still needed to be further assessed.