Diseases of the descending thoracic aorta pose a significant therapeutic challenge. The standard therapy for thoracic aneurysms or dissection is open surgical repair with prosthetic graft replacement of the diseased segment, requiring major thoracotomy. Despite important advances in surgical techniques, mortality and morbidity rates remain high. Endovascular stent-graft placement which is performed via the femoral route provides an attractive treatment alternative for thoracic aortic diseases. Due to its minimal-invasive approach, endovascular repair is also applicable for patients with contraindication to major surgery. Early results are encouraging, documenting low mortality and complication rates. However, longterm results, particularly concerning the long-term durability of the endoprostheses, are lacking, so far. Results of prospective randomized trials that compare the outcomes of endovascular repair with those of standard therapy are required before a widespread use of stent-grafts can be recommended.