Visceral (Kidney and Abdominal Organ) Function After Fenestrated and Branched Endovascular Aneurysm Repair (FEVAR/BEVAR) of Thoracoabdominal Aortic Aneurysms

This study will evaluate the effect of endovascular repair of thoracoabdominal aortic
aneurysms (Types I-IV) on visceral function using custom manufactured and off the shelf stent
grafts. Specifically, the device orientation and configuration will be evaluated with respect
to renal function. Since detailed CT scan imaging will be performed prior to and after
endovascular repair, critical data concerning each branched vessel length, tangential
orientation from the aorta, angle of incidence, and diameter can be determined. This
information can then be coupled with hemodynamic data obtained from duplex ultrasonography as
well as changes in renal volume, estimated glomerular filtration rate (eGFR), and flow
characteristics over time. By analyzing the data in this fashion, it may be possible to
determine changes in hemodynamics and/or physiologic conditions with respect to branched
stent-graft design characteristics. These data may be utilized to enhance current device
design and improve patient outcomes. The FDA has approved the use of commercially available
devices to be used in conjunction with the investigational device if the Investigator deems
this necessary.

Inclusion Criteria:

Patients may be included in the study if the patient has at least one of the following and
has aortic anatomy appropriate for treatment with the Zenith® p-Branch™, Zenith® t-Branch,
or Physician Specified TAAA Endovascular Graft (Custom Manufactured Devices).

1. Aortic Aneurysm Diameter

1. TAAA (Type I - IV) (including pararenal subtypes) with orthogonal aortic diameter
greater than or equal to 5 cm or

2. greater than two times the normal aortic diameter

2. Rapid aortic enlargement (> than or equal to 5mm in 1 year)

3. Presence of a saccular aneurysm at risk for rupture based on investigators evaluation

4. Iliac artery aneurysm ˃2.2 cm may be treated with the Zenith® Branch Endovascular
Graft-Iliac Bifurcation when the iliac artery aneurysm is associated with the
qualifying thoracoabdominal aneurysm treated in this study

Exclusion Criteria:

General Exclusion Criteria

Patients must be excluded from the study if any of the following conditions are true:

1. Less than 18 years of age

2. Unwilling to comply with the follow-up schedule

3. Inability or refusal to give informed consent

Medical Exclusion Criteria

Patients must be excluded from the study if any of the following conditions are true:

1. Known sensitivities or allergies to stainless steel, nitinol, polyester, solder (tin,
silver), polypropylene, urethane or gold

2. History of anaphylactic reaction to contrast material that cannot be adequately
premedicated

3. Leaking, ruptured aneurysm associated with hypotension

4. Uncorrectable coagulopathy

Anatomical Exclusion Criteria

Patients must be excluded from the study if any of the following conditions are true:

1. Inadequate femoral/iliac access compatible with the required delivery systems;

2. Does not have a non-aneurysmal aortic segment proximal to the aneurysm with:

1. A length of at least 4 mm, i.e. at least 4 mm circumferential wall contact around
the limits of scallop

2. A diameter measured outer wall to outer wall of no greater than 31mm and no less
than 21 mm;

3. An angle less than 60 degrees relative to the centerline of the aneurysm;

4. An angle less than 45 degrees relative to the supraceliac aorta.

3. Does not have visceral vessel anatomy compatible with Zenith® p-Branch™, specifically:

1. Renal vessel origins as measured relative to the superior mesenteric artery (SMA)
compatible with the renal fenestration, i.e. Both renal vessel origins within
7.5mm of the corresponding renal fenestrations;

2. Celiac vessel origin as measured relative to the superior mesenteric artery (SMA)
compatible with the celiac scallop.

4. A proximal seal site with unsuitable thrombus/atheroma

5. Does not have iliac artery fixation sites and anatomy consistent with:

1. Common iliac artery fixation site diameter, measured outer wall to outer wall on
a sectional image (CT) <8.0 mm (prior to deployment)

2. Iliac artery diameter, measured outer wall to outer wall on a sectional image
(CT) >21 mm at distal fixation site

3. Iliac artery distal fixation site <10 mm in length

4. Inability to preserve at least one hypogastric artery