NEXUS Aortic Arch Clinical Study to Evaluate Safety and Effectiveness

Open to people ages 18 years and up

1. Male and female age ≥ 18.
2. Proximal/ascending native or previously implanted surgical graft landing zone of appropriate length
3. Proximal/ascending native or previously implanted surgical graft landing zone of appropriate diameter
4. Distal/descending native landing zone of appropriate length
5. Distal/descending native landing zone of appropriate diameter
6. Brachiocephalic trunk native landing zone of appropriate length
7. Brachiocephalic trunk native landing zone of appropriate diameter
8. Appropriate take off angle between the Brachiocephalic Artery and the Aortic Arch perpendicular

9. Appropriate aortic arch perpendicular diameter

   10. Chronic dissection with at least one of the following conditions:

   1. An aortic aneurysm with a maximum diameter ≥ 55 mm
   2. Rapidly expanding false lumen (growth of > 0.5 cm/6 months)
   3. Compressed true lumen associated with end organ malperfusion
   4. Symptomatic
      1. Aneurysm with at least one of the following conditions:
   5. Dilatation of the aortic arch larger than 5 cm in diameter for subject with fusiform aneurysm
   6. Dilatation of the aortic arch is 1.5 times the normal diameter for subjects ascending or descending
   7. Dilation of the aortic arch larger than 2.5 cm for subject with saccular aneurysm
   8. Symptomatic aneurysm of the aortic arch
   9. Aortic diameter growth rate > 5mm per 6 months
   10. Postoperative pseudoaneurysm expanding from anastomotic suture lines
       1. Penetrating aortic ulcer with at least one of the following:
   11. Symptomatic
   12. Ulcer demonstrates expansion
       1. Intramural hematoma with at least one of the following:
   13. Symptomatic (persistent pain)
   14. Transverse or longitudinal expansion on serial imaging
       1. In the event of a lesion in the ascending aortic, the proximal/ascending native or previously implanted surgical graft the landing zone must be appropriate
          1. Femoral / iliac artery diameter as documented by CTA or MRA that allows endovascular access to the diseased site with a 20 Fr. delivery catheter.
          2. Access vessels morphology suitable for endovascular repair in terms of tortuosity, calcification and angulation, documented by CTA/MRA.
          3. Brachial/Axial Artery diameter that allows endovascular access suitable for 7 Fr.
          4. Subject is considered an appropriate candidate for an elective surgery.
          5. Subject is considered to be at high risk for open repair, as determined by the investigator.
          6. Access vessels, iliac/femoral & brachial/axillary compatible with vascular access techniques (femoral cutdown or percutaneous), devices, and /or accessories.
          7. Subject is willing and able to comply with procedures specified in the protocol and is able to return for follow-up visits as specified by the protocol.

1. Acute dissection
2. Lesions that can be safely treated with TEVAR landing in zone 2 (with or w/o LSA vascularization)
3. Required emergent treatment, e.g., trauma, rupture
4. Acute vascular injury of the aorta due to trauma
5. Aortic rupture or unstable aneurysm
6. Received a previous stent or stent graft in the treated area (including planned landing area)
7. Required surgical or endovascular treatment of an infra-renal aneurysm at time of implantation
8. Planned major surgical or interventional procedure at time of screening, to be performed after the NEXUS™ implantation.

9. Any major surgical or interventional procedure 6 weeks before the NEXUS™ implantation, exclusive of planned procedures that are needed for the safe and effective placement of the stent graft (e.g. supra-aortic bypass).

   10. Subject has had a myocardial infarction (MI) or cerebral vascular accident (CVA)

   within 90 days prior to the planned implantation

   11. Subjects with severe aortic valvular insufficiency as determined by echocardiography 12. Mechanical valve that preclude safe delivery of NEXUS™ 13. Known Connective tissue disease (e.g., Marfan's or Ehler's-Danlos syndromes) 14. Subject has an active systemic infection at the time of the procedure documented by

   pain, fever, drainage, positive culture

   15. Pregnant 16. Life expectancy of less than 2 years 17. Unsuitable vascular anatomy 18. Subject who have a previously implanted surgical wrap of the ascending aorta 19. Any medical condition that, according to the investigator's decision, might expose the

   subject to increased risk by the investigational device or procedure.

   20. An aneurysm that is mycotic, inflammatory or suspected to be infected. 21. Subject with hostile groins/axilla (scarring, obesity, or previous failed puncture)

   unless conduit are used.

   22. Subjects with severe atherosclerosis, severe calcification or extensive intraluminal

   thrombus of the aorta or in the brachiocephalic trunk

   23. Subject is suffering from unstable angina or NYHA classification III and IV. 24. Subject has a known hypersensitivity or contraindication to anticoagulants,

   antiplatelets, or contrast media, which is not amenable to pre-treatment.

   25. Subject with a contraindication to undergo angiography 26. Subject with known sensitivities or allergies to the device materials (including

   Nitinol [NiTi], polyester fabric [PET], tantalum [TA])

   27. Clinical conditions that severely inhibit x-ray visualization of the Aorta. 28. Subject has history of bleeding diathesis or coagulopathy that may limit the use of

   dual antiplatelet or anticoagulant therapy by the decision of the investigator

   29. Acute renal failure; chronic renal failure (excluding dialysis); Creatinine > 2.00

   mg/dl

   30. Any other medical, social, or psychological issues that in the opinion of the

   investigator preclude them from receiving this treatment, or the procedures and evaluations pre- and post- treatment.

   31. Active participation in another clinical study that has not completed primary

   endpoint(s) evaluation or that clinically interferes with the endpoints in this study, or subject is planning to participate in such study prior to the completion of this study.