Prospective Evaluation of Physician Modified Endografts for Aortic Disease

Inclusion Criteria:

* An aneurysm with a maximum diameter of \>5.5cm in males and \>5.0cm in females in diameter just proximal to the aneurysm using orthogonal (i.e., perpendicular to the centerline) measurements
* Aneurysm with a history of growth \> 0.5 cm in 6 months
* Saccular aneurysm deemed at significant risk for rupture
* Symptomatic aneurysm
* Extent of aorta to be treated: type II, III and IV thoracoabdominal.
* Subject is at high-risk of morbidity and mortality with open surgical repair as defined by FEV1 of \<1 liter or uncorrectable coronary disease, frailty, hostile abdomen.
* Iliac or femoral access vessel morphology that is compatible with vascular access techniques, devices or accessories, with or without use of a surgical conduit.
* Non-aneurysmal aortic segment proximal to the aneurysm (neck) with a:
* Minimum neck length of 15mm
* Diameter in the range of 17-32
* Minimum branch vessel diameter greater than 5 mm
* Iliac artery distal fixation site
* An inside diameter of 8mm - 13mm and a length of ≥ 10mm or
* an inside diameter of \> 13mm - 20mm and a length of ≥ 15mm
* Age: ≥50 years old

Exclusion Criteria:

* Can be treated in accordance with the instructions for use with a legally marketed endovascular prosthesis
* Is eligible for enrollment in a manufacturer-sponsored IDE at the investigational site
* Unwilling to comply with the follow-up schedule
* Inability or refusal to give informed consent by subject or legal representative
* Subject is pregnant or breastfeeding
* Ruptured aneurysms
* Prior aortic repair
* Patient is eligible for treatment with an FDA-approved marketed device and patient can enroll in a manufacturer-sponsored clinical study at our institution or is willing and eligible to participate in a study with a manufacturer-made device at another institution.
* Known sensitivities or allergies to the materials of construction of the devices, including nitinol, polyester, PTFE, stainless steel, platinum/iridium, tantalum markers.
* Known hypersensitivity or contraindication to anticoagulation or contrast media that cannot be adequately medically managed
* Uncorrectable coagulopathy
* Body habitus that would inhibit x-ray visualization of the aorta or exceed the safe capacity of the equipment
* Subject has had a major surgical or interventional procedure unrelated to the treatment of the aneurysm planned \< 30 days of endovascular repair
* Unstable angina (defined as angina with a progressive increase in symptoms, new onset at rest or nocturnal angina)
* Systemic or local infection that may increase the risk of endovascular graft infection
* Baseline creatinine greater than 2.0 mg/dL
* Thrombus or excessive calcification within the neck of the aneurysm
* Branch stenosis \>50% not amenable to endovascular preparation