Frailty and Physician Modified Fenestrated Endograft for Thoracoabdominal Aortic Pathologies

Inclusion Criteria: * Patients may be included in the study if the patient has at least one of the following indications and are anatomically appropriate for treatment with fenestrated/branched stent grafts. 1. Pararenal, paravisceral, and type I to IV thoracoabdominal aortic aneurysms or chronic post-dissection aneurysms with a diameter 5cm or 2 times the normal aortic diameter. 2. Aneurysm with a history of growth ≥ 0.5cm per year. 3. Saccular aneurysms deemed at significant risk for rupture based on physician interpretation. 4. Symptomatic aneurysm without hemodynamic instability 5. Aneurysms meeting any of the above criteria 1\~4, above or below the previous endovascular and/or open aortic repairs. Previously placed aortic stent graft or open aortic grafts may serve as seal zones. Exclusion Criteria: * Patients must be excluded from the study if any of the following conditions is 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 by the patient or a legally authorized representative. 4. Pregnant or breastfeeding. 5. Life-expectancy less than 2 years. 6. Participation in another investigational clinical or device trial, with the exception of participation in another investigational endovascular stent-graft protocol and performed remotely from the fenestrated procedure (\>30 days). Examples include remote (\>30days) participation in a thoracic, or abdominal branch device trial. 7. Eligible for treatment with FDA-approved marketed device. 8. Eligible and willing to travel to a center with IDE protocol wherein the device is made by a manufacturer.