Thoracic endografting is rapidly approaching trim time.

Thoracic aortic endografting is proving to be extremely useful for correcting a variety of lesions with few complications, and several devices have recently been approved by the Food and Drug Administration (FDA). Endovascular intervention avoids sternotomy or thoracotomy, chest tubes, respirators, general anesthesia, and blood loss is limited. Compared with traditional open surgery, complications such as paraplegia, renal failure, and cardiac and pulmonary difficulties are minimized; hospital and rehabilitation times are also reduced. There is no Level-1 evidence of endografting's efficacy in the thoracic aorta, and the pathologies encountered in this vascular territory are complex and often associated with other injuries or lesions, making randomized comparisons between open and endovascular procedures virtually impossible. Nevertheless, series results from centers of excellence indicate thoracic aortic endografting in patients with favorable anatomy and pathology for a specific device yields excellent results. Thoracic aortic endografting is an important alternative to open repair and will likely become the preferred treatment modality as additional devices become available and more experience is achieved in this vascular region.