Acute type B dissection is a catastrophic condition. Up to 20% of these patients develop severe complications such as rupture or branch vessel malperfusion. These challenging patients are usually triaged to surgical or endovascular management. The surgical approach has been the gold standard for treatment of complicated type B dissection. However, the management has been challenging even in centers of excellence. For these reasons, thoracic endovascular aortic repair of acute aortic dissection has gained increased interest as an initial treatment option. The goal of this therapy is to exclude the primary entry site, obliterate the false lumen, prevent aortic rupture, and relieve visceral and lower body malperfusion. The aim of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection.