Safety and Effectiveness of Physician-Modified Fenestrated and Branched Aortic Endografting for the Treatment of Thoracoabdominal and Pararenal Aortic Aneurysms

Main Arm Inclusion Criteria: * Must be a man or woman 50 years of age or older by the date of informed consent * Must have a thoracoabdominal aortic aneurysm of any Crawford classification (extent I-V) that extends no more proximal than the left subclavian artery. * Must have an aneurysm size that meets standard indications for surgical repair (6.0 cm in maximum diameter in the descending thoracic aorta, or 5.5 cm in maximum diameter in the abdominal aorta) * Must be considered, in the judgement of the Investigator, to be a high- risk candidate for open surgical repair * Must commit to comply with the five-year study assessment schedule of events * Must have a non-aneurysm-related life expectancy, in the judgement of the Investigator, of greater than 2 years Expanded Selection Inclusion Criteria: * Must be a man or woman 50 years of age or older by the date of informed consent * Must have a thoracic, thoracoabdominal, or abdominal aortic aneurysm that necessitates coverage of one or more visceral vessels (celiac, superior mesenteric, or renals) for establishment of proximal and/or distal seal. The aneurysm must not extend proximal to the left subclavian artery, or, in the setting of more proximal disease, that disease must have been previously treated. * Must have an aneurysm size that meets standard size indications for surgical repair (6.0 cm in maximum diameter in the descending thoracic aorta, or 5.5 cm in maximum diameter in the abdominal aorta); or, in the judgment o…