Penetrating aortic ulcer (PAU) is a potentially lethal lesion that should be promptly diagnosed and treated. Because of the older age and serious comorbidity of these patients, outcome with rupture of the ulcer is often ominous, even when appropriate conventional surgical treatment is given. In this study we report our experience with two cases of endovascular treatment of ruptured PAU in two elderly female patients who had evident signs of intrathoracic bleeding. Endovascular treatment was performed with a stent-graft device advanced through a 24-F sheath. The graft successfully covered the PAU in both cases and the postoperative course was uneventful. Both patients were alive and well at follow-up, with regression of the hematomas and correct positioning of the grafts. Because of the reduced invasiveness of endovascular stent-graft repair, it is an alternative therapeutic option to conventional surgery in the treatment of ruptured PAU.