Early Feasibility of the Branched TAG® Device in the Treatment of Aortic Arch Aneurysms

The GORE® TAG® Thoracic Endoprosthesis (TAG® Device) received premarket approval (PMA) for use in endovascular aneurysm repair of the descending thoracic aorta (DTA) on 23-Mar-2005 under P040043, and design changes that resulted in the conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) received premarket approval for the treatment of aneurysms of the DTA on 23-Aug-2011 (P040043/S039). The TAG® Device and CTAG are intended to exclude an aneurysm from the blood circulation in patients diagnosed with DTA aneurysms. However, endovascular treatment options for patients with aortic arch aneurysms are limited as current stent graft technology would require coverage of aortic arch vessels. This prompted the creation of the GORE® TAG® Thoracic Branch Endoprosthesis (previously known as Branched TAG® Device), which was being evaluated under IDE G130120 for Zone 2 aneurysms when this clinical investigation was initiated to evaluate the GORE® TAG® Thoracic Branch Endoprosthesis for the treatment of Zone 0 and Zone 1 aneurysms of the aortic arch.

Inclusion criteria

• Presence of aortic aneurysm involving the aortic arch deemed to warrant surgical repair which requires proximal graft placement in Zone 0 or Zone 1:

• Fusiform (≥ 55 mm), or
• Fusiform (>2 times native aortic diameter), or
• Saccular (no diameter criteria)
• Subject is considered a high risk candidate for conventional open surgical repair at the discretion of the Investigator
• Age ≥18 years at time of informed consent signature
• Subject is capable of complying with protocol requirements, including follow-up
• Informed Consent Form (ICF) is signed by Subject or legal representative
• Must have appropriate proximal aortic landing zone, defined as:

• Must require placement of the proximal extent of the Aortic Component in Zone 0 or Zone 1 for exclusion of the lesion
• Acceptable proximal landing zone outer curvature length for the required device
• Landing zone inner diameters between 16-48 mm in Zone 1 Subjects and 24-48mm in Zone 0 Subjects
• Landing zone, which must include either the brachiocephalic or left common carotid native ostium, cannot be aneurysmal, heavily calcified, or heavily thrombosed
• Must have appropriate distal aortic landing zone, defined as:

• Outer curvature length must be ≥2cm proximal to the celiac artery
• Aortic inner diameters between 16-48 mm (diameter must be between 16-42mm if using distal TAG® Device extension)
• Landing zone cannot be aneurysmal, heavily calcified, or heavily thrombosed
• Landing zone in native aorta or previously implanted GORE® TAG® Device
• Must have appropriate target branch vessel landing zone, defined as:

• Length of ≥3 cm proximal to first major branch vessel if using Aortic Component with 8 mm portal diameter, or length of ≥2.5 cm proximal to first major branch vessel if using Aortic Component with 12 mm portal diameter (required for Zone 0 Subjects)
• Target branch vessel inner diameters of 6-15 mm if using Aortic Component with 8mm portal diameter, or inner diameters of 11-18 mm if using Aortic Component with 12mm portal diameter (required for Zone 0 Subjects)
• Target branch vessel landing zone must be in native aorta that cannot be aneurysmal, heavily calcified, or heavily thrombosed

Exclusion criteria

• Concomitant aneurysm/disease of the ascending aorta, or abdominal aorta requiring repair
• Previous endovascular repair of the ascending aorta
• Previous endovascular repair of the DTA with a non-Gore device
• Surgery within 30 days of treatment
• Infected aorta
• Dissection of the aorta
• Intramural hematoma of the aortic arch or DTA without aneurysm
• Life expectancy <2 years
• Myocardial infarction or stroke within 6 weeks prior to treatment
• Patient has a systemic infection and may be at increased risk of endovascular graft infection
• Pregnant female at time of informed consent signature
• Degenerative connective tissue disease, e.g. Marfan's or Ehler-Danlos Syndrome
• Participation in another drug or medical device study within one year of study enrollment
• Known history of drug abuse within one year of treatment
• Significant thrombus or atheroma in the aortic arch
• Tortuous or stenotic iliac and/or femoral arteries preventing introducer sheath insertion and the inability to use a conduit for vascular access
• Planned coverage of celiac artery
• Patient has known sensitivities or allergies to the device materials
• Patient has known hypersensitivity or contraindication to anticoagulants or contrast media, which is not amenable to pre-treatment
• Previous instance of Heparin Induced Thrombocytopenia type 2 (HIT-2) or known hypersensitivity to heparin
• Diameter taper outside of the device sizing range between proximal and distal landing zones of aorta and the inability to use additional devices of different diameters to compensate for the taper
• Mycotic aneurysm
• Persistent refractory shock (systolic blood pressure <90 mm Hg)
• Patient has body habitus or other medical condition which prevents adequate visualization of the aorta