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The primary objective of ARISE II is to assess the safety and effectiveness of the GORE® Ascending Stent Graft device in the treatment of lesions involving the ascending aorta and aortic arch.

Inclusion Criteria: Asg Device Alone Arm

The patient is/has:

1. Ascending Aortic pathologies warranting surgical repair compatible with the

Treatment requirements of the Asg device meeting any of the following criteria:

Aneurysm

1. Fusiform aneurysm (�50mm or documented growth rate >0. 5cm/year)

2. Saccular aneurysm (no diameter criteria)

3. Pseudoaneurysms (>30 days post-surgery, no diameter criteria) Non-aneurysm

4. Penetrating Aortic Ulcers (PAUs) (no diameter criteria)

5. Pseudoaneurysms, following open surgical repair of a Type A dissection (>30 days post-surgery, no diameter criteria)

6. Anatomic compatibility with ASG device based on Gore Imaging Sciences review.

   1. Treatment must be limited to the ascending aorta

   2. Lesion location is �2cm distal to the most distal coronary artery ostia

   3. Distal extent of the lesion is located �2cm proximal to the origin of the Brachiocephalic Artery (BCA)

   4. Proximal and distal landing zones must be �2cm in length

   5. Landing zones cannot be heavily calcified, or heavily thrombosed

   6. Landing zone diameter between 27mm * 48mm

   7. For patients with prior replacement of the ascending aorta and/or aortic arch by an endovascular or surgical graft, there must be at least �2 cm overlap of ASG device and previously implanted graft.

7. Considered high-risk for open surgical repair by meeting any of the following

Criteria:

1. �75 years of age

2. Previous median sternotomy

3. Documented identification of other subject-specific risk factors (e.g., medical history, active medical diagnosis) by a study investigator and an experienced open ascending and/or aortic arch surgeon (e.g., cardiothoracic surgeon).

4. Age �18 years at time of informed consent signature

5. Adequate vascular access via transfemoral or retroperitoneal approach

6. Informed Consent Form (ICF) signed by the subject or legally authorized representative

7. Agrees to comply with protocol requirements, including imaging and 5-year follow-up

Exclusion Criteria: Asg Device Alone Arm

The patient is/has:

1. De novo Type A dissection

2. Requires immediate treatment

3. Dissected great vessels requiring treatment

4. Anticipated need for coronary or aortic valve intervention within one year post treatment

5. Any aortic valve repair or replacement including transcatheter aortic valve replacement (TAVR) or coronary artery intervention within 30 days prior to treatment

6. Complex percutaneous coronary intervention (PCI) or treatment for acute coronary syndrome requiring Dual Anti Platelet Therapy (DAPT) within 30 days prior to treatment

7. Open chest surgical repair within 30 days prior to treatment

8. Presence of Intramural Hematoma (IMH) in landing zones

9. Prosthetic heart valve in the aortic position that precludes safe delivery of the ASG device

10. Aortic insufficiency grade 3 or greater

11. Previous endovascular repair with a non-Gore device that would interfere with or

result in contact with planned repair

1. Concomitant vascular disease requiring treatment that is not planned for index

endovascular procedure

1. Any stroke or myocardial infarction within 6 weeks prior to treatment

2. Presence of protruding and/or irregular thrombus and/or atheroma in the ascending

aorta or aortic arch or any other factors that could increase the risk of stroke

based on imaging review

1. Known degenerative connective tissue disease (e.g., Marfan's or Ehler-Danlos

Syndrome, EDS)

1. Participation in investigational drug or medical device study within one year of

enrollment unless approved by the sponsor

1. Known history of drug abuse within one year of treatment

2. Pregnant at time of procedure

3. Active infected aorta, mycotic aneurysm

4. Active systemic infection (e.g., infection requiring treatment with parenteral

anti-infective medication)

1. Renal failure, defined as patients with an estimated Glomerular Filtration Rate

(eGFR) 30 days post-surgery, no diameter criteria) Non-aneurysms

1. Penetrating Aortic Ulcers (no diameter criteria)

2. Pseudoaneurysms, following open surgical repair of a Type A dissection (>30 days post-surgery, no diameter criteria)

3. Chronic de novo (>90 days) Type A aortic dissection requiring treatment

   • Chronic de novo aortic dissection with primary entry tear in the ascending aorta or arch

   • Chronic de novo aortic dissection with primary entry tear in the descending thoracic aorta with retrograde involvement of the aortic arch and/or ascending aorta

4. Residual aortic dissection following surgical repair of Type A aortic dissection requiring treatment (>30 days post-surgery)

5. Anatomic compatibility with ASG device used in combination with the TBE Device based on Gore Imaging Sciences review.

Proximal Aortic Landing Zone:

1. Landing zone is native aorta or surgical graft

2. Lesion location is �2cm distal to the most distal coronary artery ostia

3. Proximal landing zone must be �2cm in the ascending aorta.

4. Landing zone cannot be aneurysmal, heavily calcified, or heavily thrombosed

5. Landing zone diameter between 27mm * 48mm

6. Acceptable proximal landing zone outer curvature length for the required device

Branch Vessel Landing Zone:

1. Length of �2. 5 cm proximal to first major branch vessel

2. Target branch vessel inner diameters of 11-18 mm

3. Target branch vessel landing zone must be in native vessel that cannot be heavily calcified, or heavily thrombosed

Distal Aortic Landing Zone:

1. Outer curvature must be �2 cm proximal to the celiac artery

2. Aortic inner diameters between 16-42 mm

3. Landing zone in native aorta or previously implanted GORE® TAG® Conformable Thoracic Stent Graft (CTAG Device)

4. Considered high-risk for open surgical repair by meeting any of the following

Criteria:

1. �75 years of age

2. Previous median sternotomy

3. Documented identification of other subject-specific risk factors (e.g., medical history, active medical diagnosis) by a study investigator and an experienced open ascending and/or aortic arch surgeon (e.g., cardiothoracic surgeon).

4. Age �18 years at time of informed consent signature

5. Adequate vascular access via transfemoral or retroperitoneal approach

6. Informed Consent Form (ICF) signed by the subject or legally authorized representative

7. Agrees to comply with protocol requirements, including imaging and 5-year follow-up

Exclusion Criteria: Asg + Tbe Device Arm

The patient is/has:

1. Acute and subacute de novo Type A dissection (defined as