The purpose of this study was to describe our experience with balloon and self-expanding endovascular grafts for the management of thoracic aortic lesions. Between February 1997 and June 1998, 20 endovascular grafts were implanted in 14 patients for the treatment of thoracic aortic aneurysms and pseudoaneurysms. Endovascular procedures were performed using one of four different devices: (1) Dacron-covered balloon-expandable Palmaz(TM) stent, (2) balloon-expandable Palmaz stent-PTFE graft prosthesis (BE-PS), (3) self- expanding internally supported Nitinol Dacron prosthesis (Vanguard(TM) SE-V), and (4) self-expanding externally supported Nitinol PTFE prosthesis (Excluder(TM) SE-E). The results show that endovascular grafting represents a potentially important alternative therapy to open repair of the thoracic aorta. Self-expanding devices were, in our experience, easier to use and more accurately deployed.