The use of endovascular stent grafts for treatment of the descending thoracic aorta is reviewed. Currently, 3 devices have been approved by the US Food and Drug Administration for the treatment of descending thoracic aneurysms, and multiple studies are ongoing to investigate the efficacy of endovascular treatment in such pathologies as traumatic aortic injury and Stanford type B dissection. Outcomes are highly dependent on good case planning and patient selection and will likely continue to improve as newer-generation devices and delivery systems are designed and made available.