Visceral Manifold Study for the Repair of TAAA

This study is a prospective, single-center, non-randomized, single-arm study to evaluate the
therapeutic benefit of the TAAA Debranching Stent Graft System. A total of 15 patients will
be enrolled in the study.

- 10 subjects total will be treated in the primary study arm

- 5 subjects total will be treated in the expanded selection arm

The duration of the Investigation is anticipated as follows:

- Time to Complete Enrollment: 24 months

- Subject Follow-up Time: 5 years from last subject enrollment

- Total Duration Time: 7 years

The primary objective of the clinical investigation "Visceral Manifold Study for the repair
of thoracoabdominal aortic aneurysms" is to assess the use of the TAAA Debranching Stent
Graft System to repair thoracoabdominal aortic aneurysms in patients having appropriate
anatomy. The primary intent of the study is to assess safety acutely (i.e. freedom from major
adverse events (MAE) at 30 days) and preliminary effectiveness (i.e., treatment success and
technical success) of the device acutely (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.

Primary Study Arm

Inclusion Criteria:

- A patient may be entered into the study if the patient has at least one of the
following:

- 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 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 that has:

- ≥ 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

- Minimum branch vessel diameter greater than 5 mm

- Iliac artery or aortic distal fixation site, including both native tissue and
previously placed graft, 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
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

- 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), platinum, gold, polyethylene, or stainless steel.

- 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)

Anatomical exclusion criteria

- 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 Criteria Subjects who fail to meet inclusion criteria for the primary
study arm may be enrolled under an expanded selection arm if they meet the following
criteria.

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 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 Or

- Patient that meets the 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.