Safety and Efficacy of Endovascular Repair of Complex Aortic Pathology With Physician-modified Endovascular Grafts (PMEGs)

INCLUSION CRITERIA: General inclusion criteria (applicable to all 3 study arms): * Aortic pathology that fits one of the study arms (see below for detailed description) * Aortic pathology that cannot be treated within the Instructions for Use of an FDA- approved, commercially-available device * Aortic aneurysm that can be treated within the Instructions for Use of an FDA-approved, commercially-available custom-manufactured device but deemed unsafe to wait the required time for device manufacturing * Subject is at high-risk of morbidity and mortality with open surgical repair based on cardiopulmonary function, extent of comorbid disease, and anatomic complexity * Iliac and/or femoral access vessel morphology that is compatible with vascular access techniques, devices, or accessories, with or without use of a surgical or endovascular conduit * Non-aneurysmal aortic segment proximal to the aortic pathology with a: * Minimum neck length of 20 mm * Diameter between 20 - 42 mm * Non-aneurysmal aortic or iliac segment distal to the aortic pathology with: * Aortic distal fixation site greater than 20 mm in length and diameter between 20-42 mm * Iliac artery distal fixation site greater than 10 mm in length and diameter range 8- 25 mm * Age ≥21 years old * Life expectancy: ≥2 years Arm1: * Complex abdominal aortic aneurysm, specifically juxtarenal or suprarenal abdominal aortic aneurysm or type IV thoracoabdominal aortic aneurysm, with maximum diameter of ≥5.5 cm for men…