Thoracic aortic aneurysms (TAA) are potentially life-threatening conditions that must be monitored closely. Aortic aneurysms can arise at all levels of the aorta and are associated with several medical conditions and congenital syndromes. Aneurysms can progress to acute dissections and/or rupture, requiring emergent intervention. Classically, TAAs were repaired with large thoracotomies, but new techniques and technologies allow these aneurysms to be repaired by endovascular technique. Even though these techniques are minimally invasive, they still carry significant morbidity and mortality, including devastating neurologic injury from spinal cord ischemia. Lumbar spinal drains and other techniques are being used to prevent neurologic injury and improve the outcomes of TAA repairs.