Once-through helically coiled steam generator tubes subjected to external pressure are of interest because of their application to advanced small- and medium-sized integral reactors, in which a primary coolant with a relatively higher pressure flows outside the tubes, while secondary water with a relatively lower pressure flows inside the tubes. Another notable point is that the values of the mean radius to thickness ratio of these steam generator tubes are very small, which means that a thick-walled cylinder is employed for these steam generator tubes. In the present paper, the maximum allowable pressure of helically coiled and thick-walled steam generator tubes with through-wall cracks under external pressure is investigated based on a detailed nonlinear three-dimensional finite element analysis. In terms of the crack orientation, either circumferential or axial through-wall cracks are considered. In particular, in order to quantify the effect of the crack location on the maximum external pressure, these cracks are assumed to be located in the intrados, extrados, and flank of helically coiled cylinders. Moreover, an evaluation is also made of how the maximum external pressure is affected by the ovality, which might be inherently induced during the tube coiling process used to fabricate the helically coiled steam generator tubes.