Aortic diseases are highly evolutive pathological entities that may often have an acute clinical presentation. The estimated 5-year risk of rupture of a thoracic aortic aneurysm with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms of > or = 6 cm. Endovascular treatment is an emerging alternative option to surgery with low invasiveness, which allows to treat even high surgical risk patients. If almost all thoracic aortic diseases, acute or chronic, could be potentially treated with endovascular treatment, not all anatomic features of the aortic disorders allow it: vascular imaging is crucial for patient selection, endoprosthesis choice and planning of treatment. Early mid-term results of different published experiences are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of thoracic aortic aneurysms, many factors must be considered, including clinical conditions, comorbidities, anatomic situation, efficacy of materials and last, but not least, experience of a working group.