Objective. To review the results of stent graft treatment for diseases of the thoracic aorta. Design. A retrospective study of the results of thoracic stent graft procedures in a single centre. Methods. The results of 30 procedures performed in 24 patients were analysed. Eleven patients had aneurysmal dilatation Of the descending thoracic aorta (> 5.5 cm), nine patients had complicated type B dissection, three had penetrating ulcers and one had a traumatic pseudoaneurysm. Imaging follow-up consisted of CT scans performed at one, three, six and 12 months following the procedure and annually thereafter. Results. One technical failure occurred due to a ruptured external iliac artery. There were no other immediate failures. The primary technical success rate was 83%. The 30-day procedural and patient mortality rates were 7 and 8%, respectively. No neurological complications occurred. Seven patients had the subclavian artery covered without complications. Secondary intervention was required in 21%. During the follow-up period (mean 11 months, range 1-48 months.) there were five deaths, two of which were related to stent graft infection. Conclusion. Thoracic stent grafts offer a realistic alternative to surgery.