BACKGROUND: Vascular lesions involving the thoracic aorta are often life-threatening conditions that carry significant morbidity and mortality with traditional open surgical repair. METHODS: Between Jan. 2005 and Dec. 2009, 37 consecutive patients underwent endovascular stent-grafting of lesions involving the descending thoracic aorta. Attempted stent-graft deployment was performed electively in 17 patients and emergently in 20. The pathology of electively treated aortic lesions included degenerative/atherosclerotic aneurysms (n = 13), traumatic aortic transsection (n = 6), aortic dissections (n = 12 acute 6, chronic 6), intramural hematoma ( n = 4) and penetrating ulcers (n = 2). Emergently treated aortic lesions were for acute rupture due to infectious (mycotic) aneurysms (n = 1), ruptured atherosclerotic/degenerative aneurysms (n = 7), acute type B dissections (n = 5), ruptured chronic aortic dissection (n=2) and acute transsections (n = 5). There were 18 cases of aortic stent grafting for ruptured thoracic aorta. Devices used include S&G seal stent grafts (n = 34), Valiant stent grafts (n = 3). Follow-up was performed at 1-month, 6-months, 1-year, and annually thereafter. RESULTS: Primary technical success, defined as successful deployment and exclusion of the lesion without evidence of type I or type III endoleak, was achieved in 37 (100%) of 37 patients. There was no endoleak after procedure, during follow up. Major complications included four in-hospital deaths, with all of these occurring in patients treated emergently. Additionally, cerebrovascular accident (n = 1) were also observed. The causes of death were proximal endoleak because of a large proximal neck(>44mm), hypoxic brain damage, hepatic failure and rupture of an abdominal aortic dissection after throracic aortic stent grafting. There were 7 cases of intentional coverage of the left subclavian artery. Only one patient complained of intermittent left arm pain, the other patients didn���t complain of pain and dizziness. The 5 cases of ruptured traumatic aortic transsection showed complete recovery after thoracic aortic stent grafting. There was no stroke, infection, vascular injury and delayed endoleak. The overall endoleak rate was 0%, with five primary (< or = 30 days) and five secondary (> 30 days) endoleaks observed. Mean follow-up was 289 days. There were no aneurysm ruptures or aneurysm-related deaths. CONCLUSIONS: Endovascular treatment of vascular lesions involving the descending thoracic aorta can be safely performed with low morbidity in high-risk patients. Endovascular repair may become an attractive alternative for the treatment of a wide range of pathology along this vascular territory.