Background and Objects: Operative mortality was high in complicated descending aortic dissection especially, malperfusion syndrome. Three methods of endovascular treatment were developed(aortic stent graft, fenestration, selective branch artery stenting). There were a few data with the safety and long term clinical outcome after endovascular treatment for complicated descending aortic dissection and malperfusion syndrome. So, the objective of this study is to investigate safety and mid-term clinical outcome after endovascular treatmentment for complicated aortic dissection and malperfusion syndrome. Methods and Results: This was the observational retrospective study. 17 patients who were managed with endovascular treatment from Jan. 2005 to Dec. 2010 at our hospital were enrolled. Mean age of patient was 58.2짹15.6 years old. The 17 patients consisted of 12 cases of acute aortic dissection, 5 cases of chronic aortic dissection with huge aneurysm formation. 8 cases of malperfusion syndrome were treated with aortic stent graft(n=3), selective branch artery stenting(n=7, renal 4, celiac 3 carotid 1 common iliac 2), fenestration(n=1), combined procedure(n=4). There were 4 cases of aortic stent grafting for ruptured aortic dissection. There was 1 case of in-hospital mortality. The causes of death was hepatic failure because of compromised celiac trunk. Mean follow up duration was 19.3짹11.2 months. Mortality of complicated aortic dissection managed with endovascular treatment showed 11.8%(2/17) during follow up. Mortality of malperfusion syndrome managed with endovascular treatment was 12.5%(1/8). Rate of reintervention was 11.8%(2/17). 2 cases of chronic aortic dissection with huge aneurysm formation were relapsed aortic dissection in the distal part of aortic stent graft which were managed with additional stent graft. Conclusion: Endovascular treatment for complicated aortic dissection and malperfusion syndrome was a safe procedure with good mid-term clinical outcomes. More clinical data and long term follow up are needed.