Thoracic endovascular aortic repair (TEVAR), introduced by Dake et al in 1994,¹ has emerged as the preferred management strategy for multiple pathologic entities in the descending thoracic aorta such as complicated type B aortic dissection, fusiform and saccular aortic aneurysm, penetrating aortic ulcer, and blunt traumatic rupture.²,³ TEVAR is less invasive than conventional open aortic repair and has also been successfully applied in more frail patients who are not candidates for conventional open repair. Unlike open repair, which requires significant physiologic reserve, TEVAR has anatomical constraints, such as adequate landing zones and access vessels needed for device delivery. Although open surgical repair is commonly used when TEVAR is not possible, several advances such as branched/fenestrated devices⁴ and controlled rupture of iliofemoral vessels⁵ have made endovascular procedures possible in these more complicated clinical scenarios. Complications unique to TEVAR include endoleak, stent graft-induced new entry tears, and less commonly, stent migration.⁶,⁷,⁸,⁹ Neurologic complications such as spinal cord ischemia can occur after extensive coverage of the descending thoracic aorta.¹⁰ In this chapter we will illustrate the use of TEVAR in several case scenarios and in stepwise complexity from treatment of an isolated descending aortic aneurysm to one encompassing use of branched endografts. For each case, we will present images in sequence from preoperative diagnosis to intraoperative angiograms and postoperative results. The accompanying legends will provide explanation about the specific phase of the procedure.