Safety, Efficacy, Longitudinal Costs and Patient-Centered Outcomes Using a TAAA Debranching Device

Inclusion Criteria: Modified 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 Other inclusion criteria: * 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 healthy/nondiseased tissue (including previously placed graft material) (neck) distal to the left subclavian artery (LSA) diameter in the range of 26-42 mm * ≥2.5cm of surgical graft distal to the left subclavian artery (LSA) diameter in the range of 26-42mm. * 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 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 * Patency of the four major visceral vessels (SMA, celiac, right renal, left renal) * Age: ≥ 18 years old * Life expectancy: \> 1 year Exclusion Criteria General exclusion * Patient is a good candidate for and elects 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 investigational device exemption (IDE) at the investigational site * Unwilling to comply with the follow-up schedule * Inability or refusal to give informed consent by patient or legal representative * Patient is pregnant or breastfeeding * Patient has a contained rupture * Patient has a ruptured aneurysm * Patient has a dissection in the treated portion of the aorta * Obstructive stenting of any or all of the visceral vessels 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 * Branch stenosis ≥ 70% * 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