Recently, endovasular stent grafting of the aorta has received increasing attention, as a promising, less-invasive alternative to open surgical repair. The aim of the present work was to assess the technical aspects, morbidity, short and mid term outcome of endovascular grafting in both type B aortic dissection and descending thoracic and abdominal aortic aneurysms compared to surgically treated patients. To achieve this purpose we studied 194 patients who presented to San Donato hospital in Milan, Italy, between January 2002 and January 2004 with either type B thoracic aortic dissection (55pts) or aortic aneurysms (descending thoracic in 44 pts, or abdominal in 95 pts). We can conclude that in patients with uncomplicated type B aortic dissection medical therapy is their best therapeutic option. In patients with complicated type B aortic dissection and descending thoracic aortic aneurysms endovascular grafting offers a less invasive, lower morbidity, and lower mortality than conventional surgical grafting. While in patients with abdominal aortic aneurysms the high cost of endovascular grafting may only be justified in patients with high surgical risk.