Visceral Manifold and Unitary Device Study for the Repair of Thoracoabdominal Aortic Aneurysms

The primary objective of the clinical investigation Visceral Manifold and Unitary Device
Study is to assess the use of the thoracic bifurcation and the visceral manifold or the
unitary stent graft system to repair thoracoabdominal aortic aneurysms in patients having
appropriate anatomy. The primary intent of the study is to assess safety (i.e. freedom from
major adverse events (MAE) at 30 days) and preliminary effectiveness (i.e., treatment success
and technical success) of the device (i.e., the proportion of treatment group subjects that
achieve and maintain treatment success at one year). Additionally, the study will assess
technical success and treatment success at each follow-up interval.

Inclusion Criteria:

- An aneurysm with a maximum diameter of ≥ 5.5 cm or 2 times the normal 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 greater than or equal to 4.5 cm

- Axillary or brachial and iliac or femoral access vessel morphology that is compatible
with vascular access techniques, devices or accessories, with or without use of a
surgical conduit

- Proximal landing zone for the thoracic bifurcation stent graft:

•≥ 2.5 cm of nonaneurysmal aortic segment including previously placed graft material
(neck) distal to the left subclavian artery (LSA)

- Diameter in the range of 26-42 mm

- Adequate distance from the celiac artery, in order to accommodate cannulation
from the antegrade access point when considering the total deployed length of the
thoracic bifurcation and visceral manifold

- Proximal landing zone for the unitary manifold stent graft:

- Nonaneurysmal aortic segment including previously placed graft material (neck)
with a minimum seal zone length of 3 cm

- Diameter in the range of 19-32 mm

- Iliac artery or aortic distal fixation site greater than or equal to 15 mm in length
and diameter in the range of 8 - 25 mm

- Age: ≥ 18 years old

- Life expectancy: > 1 year

Exclusion Criteria:

General exclusion

- Patient is a good candidate for and elects for open surgical repair

- Can be treated in accordance with the instructions for use with a legally marketed

- 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

- Urgent or emergent presentation

- Patient is pregnant or breastfeeding

- Patient has a contained rupture

- Patient has a ruptured aneurysm

- Patient has a dissection in the portion of the aorta intended to be treated

- Obstructive stenting of any or all of the visceral vessels

- Poor performance status including two major system failures (cardiovascular,
pulmonary, renal, hepatobiliary, and neuromuscular)

Medical exclusion criteria

- Known sensitivities or allergies to the materials of construction of the devices,
including nitinol (Nickel:Titanium), polyester, platinum-iridium,
polytetrafluoroethylene (PTFE)

- 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 exceeds the safe
capacity of the equipment

- Patient has had a major surgical or interventional procedure unrelated to the
treatment of the aneurysm planned < 30 days of the 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

- History of connective tissue disorders (e.g., Marfan Syndrome, Ehler's Danlos
Syndrome)

- Prior aneurysm repair that would involve relining of the previously placed graft
material requiring placement of the investigational system in a landing zone that
expands beyond any limits of the previously placed graft material

Anatomical exclusion criteria

- Minimum branch vessel diameter less than 5 mm

- Thrombus or excessive calcification within the neck of the aneurysm

- Anatomy that would not allow maintenance of at least one patent hypogastric artery

- Anatomy that would not allow primary or assisted patency of the left subclavian artery

Expanded Selection Arm Inclusion Criteria

Patient that meets the criteria for inclusion in the primary study arm but has one or more
of the following criteria which would exclude them from the primary study arm:

- Minimum branch vessel diameter less than 5 mm

- Urgent or emergent presentation

- Patient has a contained rupture

- Patient has a ruptured aneurysm

- Patient has a type B dissection (subacute or chronic) in the portion of the aorta
intended to be treated

- Poor performance status including two major system failures (cardiovascular,
pulmonary, renal, hepatobiliary, and neuromuscular)

- Baseline creatinine greater than or equal to 2.0 mg/dL

- Anatomy that would not allow for maintenance of at least one hypogastric artery

- Anatomy that would not allow for primary or assisted patency of the left subclavian
artery

- Prior aneurysm repair that would involve relining of the previously placed graft
material requiring placement of the investigational system in the a landing zone that
expands beyond any limits of the previously placed graft material

- Obstructive stenting of any or all of the visceral vessels

OR

Patient that meets criteria for inclusion in the primary study arm and:

- Would not be eligible for the primary study arm per a documented reason other than
those outlined above, and

- Per the opinion of the Principal Investigator, with concurrence of the IRB,
alternative therapies are unsatisfactory and the probable risk of using the
investigational device is no greater than the probable risk from the disease or
condition.