Descending thoracic aortic aneurysmal disease is associated with poor 5-year survival rates as low as 10%-15% if untreated. This is probable because of a combination of the aneurysmal disease, comorbidities, and in many patients advanced age. In the search for better outcomes and newer techniques, the endovascular approach for the treatment of these aneurysms has developed over the last 20 years. Many advances in the materials and techniques have been made since the first reports of abdominal and thoracic aortic endovascular repair in the early 1990s. Currently, clinical trials have proven that several different commercially available endovascular grafts can be deployed safely, with early results equal to or better than conventional open repairs. Most of the data reported have been on early and midterm results. Now with continued observation, the long-term outcomes of these novel techniques can be determined over the next decade. © 2009 Elsevier Inc. All rights reserved.