Endovascular repair of descending thoracic aortic aneurysm using stent graft was introduced and rapidly adopted in the early 1990s for selected cases with suitable anatomy to prevent high morbidity of surgical thoracic aortic aneurysm repair. Since then, the indications of endovascular repair have expanded with or without adjunct surgical interventions, technology and devices have continued to be refined, and branched stent grafts are in various study phases. This chapter touches on indications, preoperative considerations, procedural details, hybrid repair techniques, and potential complications and management of those.