This is an early feasibility study that investigates the outcome of selected patients with complex thoracoabdominal aortic lesions who are suitable for endovascular (within the vessel) repair with a physician-modified Medtronic Thoracic Valiant stent graft. The Medtronic Valiant System includes a Valiant Thoracic Stent Graft, a self-expanding, tubular end prosthesis which is modified/customized by the Investigators to fit the patient's anatomy. The device is constructed by making a taper in the larger proximal thoracic device and attaching it to a smaller distal thoracic device. The Viabahn branches for the visceral vessels are sutured to holes made in the tapered section. The modified Valiant stent graft is advanced to the lesion site endoluminally via the iliac/femoral artery. Access for delivery of extensions to the device will be delivered through the left subclavian artery. Upon deployment, the stent graft self-expands at the target location, where it is designed to exclude the lesion by restoring blood flow through the stent graft lumen.
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Inclusion Criteria: * Patients must have a Type IV complex thoracoabdominal aortic lesion and be considered candidates for endovascular repair; * Patients must have an ileofemoral access compatible with delivery of a 25 Fr MedtronicValiant thoracic endograft; * Patients must have a left subclavian artery anatomy compatible with 8 mm Dacron conduit to provide safe, sequential antegrade deployments of branch extensions * Patients must have a nonaneurysmal proximal aortic segment distal to the left subclavian artery with at least 2 cm length to assure secure proximal fixation with a * Minimum diameter of 28 mm * Maximum diameter of 42mm * Angle less than 60° relative to axis of the aneurysm * Angle less than 60° relative to axis of the thoracic aorta; * Patients must have a distal fixation iliac artery diameter greater than 2 cm in length and 12-28 mm in diameter; * Patients must be high-risk surgical candidates according to the following established criteria: ASA score of IV. Exclusion Criteria: * Pregnant or pediatric patients (younger than 21 years of age); * Patients who have a condition that threatens to infect the stent graft/aortic valve prosthesis; * Patients with allergies to the stent graft material; * Patients who fail to sign informed consent; * Patients with expected survival less than one year.