Descending thoracic and abdominal aortic aneurysms represent a potential life-threatening situation. Resection and graft replacement of the pathologically altered aorta used to be the preferred method of treatment. Although progress has been achieved during the past decades in the management of patients with thoracic aortic aneurysms by new surgical techniques, intraoperative monitoring of somatosensory-evoked potentials, and spinal cord fluid drainage, postoperative morbidity and mortality rates still remain high. The afflicted population is usually of older age and present at the time of operation with various comorbidities such as hypertension, obstructive pulmonary disease, coronary heart disease, all of which with significant impact on surgical outcome. Postoperative complications, such as paraplegia, renal and pulmonary disease, contribute to prolonged hospital stay and higher medical cost. In this review we report on a promising alternative approach to the surgical treatment of thoracic and abdominal aortic aneurysms, namely the currently emerging utilization of the endovascular stent-graft prosthesis in both thoracic and abdominal aneurysm.