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Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent- graft placement for the treatment of patients with PAUs. Methods: Between July 1999 and December 2004, endovascular stent- graft repair of PAU was performed in 22 patients(69.1± 7.8 years, 16 men), 3(14% ) of whom had contained aortic rupture. Stent- graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access. Results: Procedural success was achieved in all but 1 patient(technical success rate 96% ). Postoperatively, 1(5% ) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow- up of 27(range 1- 62) months, 1 patient underwent adjunctive stent- graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow- up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years. Conclusions: Endovascular stent- graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.