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…