The indications for endovascular therapy of thoracic aortic pathologies are expanding. The complexity of cases is increasing. The individual anatomy and pathology of the thoracic aorta alone and in combination create specific difficulties in stent graft delivery, deployment, and fixation. Graft design has evolved, and several new iterations of stent grafts have been introduced into clinical practice. The assessment of these new grafts is difficult, due to the changing indications for their use and a lack of large-scale clinical trials. Currently, a number of thoracic stent graft devices are available in Europe. Variable amounts of clinical data are available to support their use.