Aortic disease is the most life-threatening complication of Marfan syndrome. Over the last decades, improved medical management and surgical results of prophylactic aortic interventions on the aortic root have dramatically increased expectancy of life in Marfan syndrome patients. As a result, the number of Marfan syndrome patients requiring secondary interventions on the thoracic or thoraco-abdominal aorta due to development of aortic disease or new type B dissection, has substantially increased. In this setting, open surgical interventions represent the treatment of choice. Nevertheless, the available literature, although restricted to small case series, indicates that endovascular repair is a feasible treatment option leading to satisfactory short-term results and may provide a bridging role to definitive open reconstruction. The aim of this paper was to review surgical and endovascular outcomes of aortic disease in Marfan syndrome.