FENESTRIATED ENDOPROSTHESIS OF THE THORACIC AORTA

Description

[0001] The present invention relates to the field of endoprostheses, and more particularly to the field of thoracic aortic endoprostheses.

[0002] An aneurysm is a localized dilation of the wall of an artery. An aneurysm is defined as a loss of parallelism between the edges of the vessel and a vessel caliber greater than 1.5 times normal.

[0003] The main risk is that of rupture of the aneurysm, which is most often fatal.

[0004] While any artery can be affected, the aorta is frequently affected. It is the largest artery in the human body.

[0005] All aortic aneurysms inexorably increase in size over time and the risk of rupture becomes significant as soon as the diameter of the aorta exceeds 5 cm.

[0006] However, if an aneurysm is detected early, it is possible to prevent its rupture by open surgery, the indication being formal when the diameter exceeds 5.5 cm. However, this intervention at the thoracic level is associated with significant morbidity and mortality. Since the early 1990s, a less invasive treatment involving the placement of an endoprosthesis from the femoral artery has been proposed for descending aortic aneurysms: endovascular repair.

[0007] Aortic dissection is a breach in the aortic wall, causing blood to leak into the wall and divide it in two. This creates two channels. Aortic dissection is a serious condition that affects three people per 100,000 inhabitants. It can affect the ascending aorta, the descending aorta, or both. When it affects the ascending aorta, the standard treatment is emergency open surgery to replace the aorta. In the descending aorta, the standard treatment is medical treatment alone. In the event of complications, endovascular treatment with a stent graft is then performed.

[0008] The endoprosthesis is a stent (i.e., a tubular, meshed metal device, commonly called a "spring") associated with a waterproof wall (also called a "stent graft"), deployed inside the artery at the site of the aneurysm. It isolates the latter from the blood flow, and recreates a cylindrical section of artery in its place.

[0009] The aorta is divided into two parts, the ascending aorta at the thoracic level and the descending aorta at the thoracic and abdominal levels.

[0010] Treating aneurysms and dissections of the descending aorta by endovascular means has become the standard treatment.

[0011] However, regarding the ascending part of the aorta, the standard treatment remains open surgery. This is mainly due to the anatomical complexities of the area: the aorta takes the form of an arch and is surrounded by noble vessels that cannot tolerate obliteration: coronary ostia, supra-aortic trunks vascularizing the brain.

[0012] International patent application WO2007 / 028086 describes a thoracic endoprosthesis adapted to the aortic arch thanks to the presence of "windows" in the wall of the stent opposite the three vessels, these windows allowing blood to pass through the prosthesis and thus vascularize the vessels destined for the head, neck and arms.

[0013] However, the placement of this endoprosthesis is delicate, since care must be taken to ensure that it does not rotate during its introduction, otherwise the windows would not be placed opposite the vessels, and they would be totally or partially obstructed, which would be fatal for the patient.

[0014] In addition, the intervention time related to the deployment of the endoprosthesis remains between three and six hours, which constitutes a major intervention, under general anesthesia. The complexity of the procedure requires implementation in expert centers by experienced operators, thus limiting the diffusion and democratization of this treatment.

[0015] This procedure requires the placement of guides in the neck vessels and is therefore associated with a high risk of stroke. There also remains the problem of anchoring the prosthesis to prevent it from moving in the direction of blood flow.

[0016] Finally, these types of endoprostheses need to be custom-built based on the patient's scan and therefore require a long delivery time (on average one month), which is incompatible with the emergency treatment of these pathologies.

[0017] Document WO 2011 / 041773 A1 relates to an endoprosthesis with two lateral branches intended to be inserted into the supra-aortic trunks. This type of endoprosthesis also requires custom construction based on the patient's scan and requires a significant operating time for its placement in the patient's body since the branches also need to be inserted into the supra-aortic trunks. The complexity of the procedure requires implantation in expert centers by experienced operators, thus limiting the diffusion and democratization of this treatment.

[0018] US 2011 / 270380 A1 describes an endovascular prosthesis that includes a tubular body and an external connector expandable from a collapsed configuration against the tubular body to an expanded position.

[0019] As with the previous document, this type of endoprosthesis requires a custom design and presents a significant intervention time due to the ramifications it presents. The complexity of the procedure requires implementation in expert centers by experienced operators, thus limiting the diffusion and democratization of this treatment.

[0020] To this end, the present invention aims to enable the treatment of aneurysms and dissections of the ascending aorta including the aortic arch at the thoracic level, with maximum safety, while reducing the complexity of the surgical procedure.

[0021] More particularly, the subject of the invention is a fenestrated endoprosthesis of the thoracic aorta comprising a first mesh of stents, a main tubular endoprosthesis made of fabric, said main tubular endoprosthesis being integral with said first mesh of stents, and having an arcuate central portion configured to be housed in the aortic arch of a patient, said arcuate central portion extending between a first end configured to be housed in a portion of the ascending aorta and a second end configured to be housed in a portion of the descending aorta, the fenestrated endoprosthesis of the thoracic aorta further comprising a collar also made of fabric and associated with a second mesh of stents, said collar being of substantially frustoconical shape and provided with a base, said base of the collar being attached to an opening made on the upper face of the arcuate central portion of the main tubular endoprosthesis,said collar being configured to be housed at the base of the patient's supra-aortic trunks.,

[0022] Optional, complementary or substitutive features of the invention are set out below.

[0023] According to certain characteristics, the second stent mesh may consist mainly of a mesh extending over the entire circumference of the collar following substantially sinusoidal convolutions, the radial force of said mesh making it possible to press the collar against the wall of the base of the supra-aortic trunks and thus reduce the risk of endoleaks.

[0024] According to other characteristics, the second mesh of stents may consist mainly of several separate meshes radially offset from each other, extending over the entire circumference of the collar following substantially sinusoidal convolutions, the radial force of said mesh making it possible to press the collar against the wall of the base of the supra-aortic trunks and thus to reduce the risk of endoleaks.

[0025] According to other characteristics, the second stent mesh may further comprise an elliptical mesh or one defining the contour of a hyperbolic paraboloid surface, at the base of the collar, so as to maintain the opening made on the upper face of the arcuate central part of the main tubular endoprosthesis.

[0026] According to still other characteristics, the first stent mesh may consist mainly of several disjointed meshes, each extending in a circular manner over the entire circumference of the main tubular endoprosthesis following substantially sinusoidal convolutions, the radial force of said mesh making it possible to press the main tubular endoprosthesis against the aortic wall and thus to reduce the risk of endoleaks.

[0027] According to still other characteristics, the first mesh of stents can comprise at least one mesh attached to the second mesh of stents, so as to prevent kinks of the main tubular stent. Kinks correspond to folds formed by the body of the stent during poor deployment of the prosthesis or during significant external constraints, and can lead to poor flow of blood ranging from simple stenosis to occlusion of the prosthesis.

[0028] According to still other characteristics, the first mesh of stents can comprise at least one mesh attached to the mesh of the base of the collar, so as to prevent kinking of the main tubular endoprosthesis.

[0029] Advantageously, at least one of the ends of the main tubular stent or the free end of the collar may be an area of ​​exposed mesh devoid of tissue.

[0030] The fabric covering the stent meshes can preferably be chosen from the list defined by braided polyesters, braided Dacron, PTFE.

[0031] The stent meshes may preferably be made of a shape memory alloy, preferably a Nickel-Titanium alloy.

[0032] Advantageously, the fenestrated endoprosthesis of the thoracic aorta may comprise radiopaque markers, preferentially arranged at the ends of the main tubular endoprosthesis and / or the free end of the collar.

[0033] According to a particular embodiment, the first mesh can extend over the collar.

[0034] According to another particular embodiment, the second mesh can extend beyond the main tubular endoprosthesis.

[0035] Advantageously, a reinforcement may extend along the convex face of the arcuate central portion of the main tubular stent, and even more advantageously along the entire length of said main tubular stent.

[0036] Preferably, this reinforcement is made of nitinol or suture thread.

[0037] Other advantages and particularities of the invention will appear on reading the detailed description of implementations and embodiments which are in no way limiting, and the following appended drawings: [ Fig.1 ] This figure represents a schematic side view of a thoracic endoprosthesis according to a particular embodiment of the invention. Fig.2 ] This figure represents a schematic side view of a thoracic endoprosthesis placed in the aortic arch of a patient according to a particular embodiment of the invention. Fig.3 ] This figure represents a schematic top view of a thoracic endoprosthesis according to a particular embodiment of the invention. [ Fig.4 ] This figure represents a schematic side view of a thoracic endoprosthesis according to the invention accompanied by the dimensions. Fig.5 ] This figure represents a schematic top view of a thoracic endoprosthesis according to the invention accompanied by the dimensions. Fig.6 ] This figure represents a schematic profile view of an aortic arch of a patient equipped with a thoracic endoprosthesis according to a particular embodiment of the invention. Fig.7 ] This figure represents a schematic side view of a thoracic endoprosthesis according to a particular embodiment of the invention. Fig.8 ] This figure represents a schematic top view of a thoracic endoprosthesis according to a particular embodiment of the invention. [ Fig.9 ] This figure represents a schematic side view of a thoracic endoprosthesis placed in the aortic arch of a patient according to a particular embodiment of the invention.

[0038] The embodiments described below being in no way limiting, it will be possible in particular to consider variants of the invention comprising only a selection of characteristics described, isolated from the other characteristics described even if this selection is isolated within a sentence comprising these other characteristics, if this selection of characteristics is sufficient to confer a technical advantage or to differentiate the invention in relation to the information of the prior art.

[0039] This selection includes at least one feature, preferably functional without structural details, or with only a part of the structural details if this part only is sufficient to confer a technical advantage or to differentiate the invention from the prior art information.

[0040] According to the invention and as shown in the figure 1 and on the figure 6 , the fenestrated endoprosthesis of the thoracic aorta comprises a first mesh of stents 2 as well as a main tubular endoprosthesis 1 made of biocompatible fabric forming a sealed envelope, the main tubular endoprosthesis 1 recreating a cylindrical vessel and isolating the sac formed by the aneurysm from the blood circulation.

[0041] The main tubular stent has an arcuate central portion 12 configured to be housed in the aortic arch of a patient. This arcuate central portion 12 extends between a first end 10 configured to be housed in a portion of the ascending aorta AA and a second end 11 configured to be housed in a portion of the descending aorta AD.

[0042] Advantageously, the fabric constituting the main tubular endoprosthesis can be chosen from the list defined by braided polyesters, braided Dacron, PTFE.

[0043] This fabric can for example be PTFE such as laminated Teflon ®< or Dacron ®<, these materials being commonly used in simple endoprostheses.

[0044] In addition, the outer diameter and length of the unfolded main tubular stent are advantageously chosen to be between 25 and 60 mm and between 180 and 450 mm, respectively. These dimensions allow the main tubular stent 1 to be perfectly adapted to the morphology of the aortic arch (also called aortic arch) of the patients.

[0045] The invention is not, however, limited to particular dimensions or materials. Those skilled in the art will be able to adapt it to suit individual cases.

[0046] According to the invention, the main tubular endoprosthesis 1 comprises on the upper face of its arcuate central part 12, an opening 13.

[0047] The term "upper face" means the convex portion of the central arcuate part 12, that is to say the one which is opposite the base of the supra-aortic trunks.

[0048] According to the invention, the fenestrated endoprosthesis of the thoracic aorta further comprises a collar 3 also made of fabric and associated with a second mesh of stents 4.

[0049] This collar 3 is configured to be housed at the base of the patient's TSA supra-aortic trunks.

[0050] The term "located at the base of the supra-aortic trunks" means that the collar is opposite the supra-aortic trunks and therefore does not engage with any of the supra-aortic trunks.

[0051] It is precisely this position of the collar at the level of the main aorta which allows the "universality" of the endoprosthesis as well as the simplicity and speed of implantation.

[0052] The collar 3 is of substantially truncated cone shape and its base 30 may be substantially elliptical.

[0053] The base of the collar can also advantageously define the contour of a hyperbolic paraboloid surface. This geometry in fact allows the widest possible opening of the collar, which thus makes the collar compatible with most anatomical variations of the supra-aortic trunks. In other words, the three-dimensional character of the hyperbolic paraboloid surface allows a maximum widening of the opening 13 in the three planes of space: anteroposterior, lateral, supero-inferior. Advantageously, the dimensions of the major axes at the base and at the top of the frustoconical collar 3 are respectively chosen between 50 and 150 mm and between 50 and 130 mm, in order to adapt perfectly to the morphology of the aortic arch of the patients.

[0054] Similarly, the dimensions of the small axes at the base and at the top of the truncated cone-shaped collar 3 are respectively chosen between 25 and 60 mm and between 10 and 50 mm, in order to adapt perfectly to the morphology of the aortic arch of the patients.

[0055] The truncated cone-shaped collar 3 preferably extends over a length of between 8 and 40 mm.

[0056] The invention is not, however, limited to particular dimensions or materials. Those skilled in the art will be able to adapt it to suit individual cases.

[0057] The base of the collar 3 is attached to the opening 13 made on the upper face of the central arcuate part 12 of the main tubular endoprosthesis 1.

[0058] By reported, we mean that the collar 3 is attached to the main tubular endoprosthesis 1 at the opening 13.

[0059] The assembly formed by the main tubular endoprosthesis and the collar can be produced in a single piece, for example by 3D printing.

[0060] Alternatively, the collar 3 may be sutured to the main tubular stent 1 by gluing or sewing, for example, with the opening 13 being drilled in the main tubular stent 1 before suturing. The suture must ensure the tightness of the junction between the main tubular stent 1 and the collar 3.

[0061] The collar 3 is preferably made of the same fabric as the main tubular stent 1.

[0062] The main tubular stent 1 is associated with the first mesh of stents 2, in that the stents of the first mesh are fixed generally on the external face of the main tubular stent, so that the stents maintain the main tubular stent in its required shape.

[0063] Other non-limiting configurations in which the stents are impregnated in the tissue or arranged against the internal face of the main tubular endoprosthesis 1 are also conceivable.

[0064] Preferably, the stents are made of shape memory alloy, such as for example Nickel-Titanium alloys and in particular Nitinol.

[0065] According to other non-limiting configurations, the stents can be, for example, Z-stents ®< made of a Chrome and Cobalt alloy.

[0066] Advantageously, the first stent mesh 2 may consist mainly of several separate meshes, each extending in a circular manner around the entire circumference of the main tubular endoprosthesis 1.

[0067] Preferably, these meshes can extend along substantially sinusoidal convolutions or in a zigzag shape, so that the meshes deform like springs.

[0068] Thus, the radial force of said mesh makes it possible to press the main tubular endoprosthesis 1 against the aortic wall and thus reduces the risk of endoleaks.

[0069] According to other non-limiting configurations, the stents can be connected two by two by a plurality of connecting means. The connecting means can be the subject of numerous embodiments, but generally can consist of metal bars (for example also made of an alloy of Chromium and Cobalt, or of Nitinol) fixed at their two ends to the structure of the stents, for example by means of a loop or a hook surrounding a mesh of a stent.

[0070] With regard to the collar 3, the latter is associated with the second mesh of stents 4, in the sense that the stents of the second mesh are generally fixed on the external face of the collar, so that the stents maintain the collar in its required shape.

[0071] Other non-limiting configurations in which the stents are impregnated in the tissue or arranged against the internal face of the main tubular endoprosthesis 1 are also conceivable.

[0072] Preferably, the second stent mesh 4 consists mainly of a single mesh, which extends over the entire circumference and over the entire length of the collar 3.

[0073] Preferably, this mesh can extend along substantially sinusoidal convolutions or in a zigzag shape, so that the mesh deforms like a spring.

[0074] Thus, the radial force of the second mesh of stents 4 makes it possible to press the collar 3 against the wall of the base of the TSA supra-aortic trunks and thus reduces the risk of endoleaks.

[0075] As shown on the figure 2 and on the figure 6 , we see that the wall of the base of the TSA supra-aortic trunks tends to exert pressure on the collar 3 which in turn exerts counter pressure against the wall of the base of the supra-aortic trunks, thanks to the second mesh of stents 4.

[0076] According to an alternative embodiment, the second stent mesh 4 is mainly made up of two separate meshes radially offset from each other, so as to reinforce the support of the collar produced by the two stent meshes.

[0077] Preferably, the stents of the second mesh are made of shape memory alloy, such as for example Nickel-Titanium alloys and in particular Nitinol.

[0078] According to other non-limiting configurations, the stents can be, for example, Z-stents ®< made of a Chrome and Cobalt alloy.

[0079] Advantageously, the second mesh of stents 4 may further comprise an elliptical mesh 40 at the base 30 of the collar 3, so as to maintain the opening 13 made on the upper face of the arcuate central part 12 of the main tubular endoprosthesis 1.

[0080] With this same purpose, the second mesh of stents 4 may further comprise a mesh defining the contour 40' of a hyperbolic paraboloid surface.

[0081] Also advantageously, the first mesh of stents 2 may comprise at least one mesh 22 attached to the second mesh of stents 4, so as to prevent kinking of the main tubular endoprosthesis 1.

[0082] This mesh 22 can preferably be attached to the elliptical mesh 40 or to the mesh 40' defining the contour of a hyperbolic paraboloid surface of the base 30 of the collar 3, so as to prevent kinks of the main tubular endoprosthesis 1.

[0083] As depicted on the figures 7, 8 And 9 , and in order to keep the collar 3 as vertical as possible and thus prevent it from collapsing, the first mesh 2 advantageously extends beyond the collar 3 over portions 24 of the collar, in order to reinforce the deployment of the collar against the supra-aortic trunks.

[0084] More specifically, some meshes of the first mesh extend to the collar so as to form an incomplete circle. Their presence makes it possible to limit the secondary mesh on the collar and thus to reduce the size of the fenestrated stent. This results in a miniaturization of the stent, which makes it possible to use a launcher of smaller diameter allowing it to be introduced into smaller femoral arteries.

[0085] Of course, as a variant and with the same purpose, the second mesh 4 can also extend onto the main tubular endoprosthesis 1 according to this same principle.

[0086] Advantageously, a reinforcement 6 extends along the convex face of the arcuate central portion 12 of the main tubular endoprosthesis 1, and preferably over the entire length of said main tubular endoprosthesis. Thus, this reinforcement makes it possible to avoid “accordion” type kinks in the longitudinal direction, and consequently promotes the deployment of the endoprosthesis over its entire length.

[0087] This reinforcement 6 can be, for example, made of nitinol or made of suture thread on the fabric.

[0088] In order to facilitate the anchoring of the main tubular stent, one of the ends of the main tubular stent may be an area of ​​visible mesh 20, 21 devoid of tissue called “free flow” in English.

[0089] Likewise, the free end 31 of the collar 3 may be an area of ​​visible mesh 41 devoid of fabric.

[0090] These visible mesh areas 20, 21 and 41 are in fact made up of a mesh extending along substantially sinusoidal or zigzag-shaped convolutions. The peaks of the sinusoidal curve or the zigzags can then be brought together or separated in the radial direction, that is to say the direction perpendicular to that which corresponds to the flow of the blood.

[0091] These visible mesh zones 20, 21 and 41 extend over a distance less than or equal to 20 mm.

[0092] The apices can be brought together in the radial direction when placing the fenestrated stent graft in the thoracic aorta by means of a cone and a delivery guide.

[0093] Once the positioning in the aorta is stopped, the mesh tends to return to its initial shape and the vertices move apart in the radial direction to anchor themselves in the wall of the ascending aorta AA, in the wall of the descending aorta AD and in the wall of the base of the supra-aortic trunks TSA.

[0094] In order to facilitate the placement of the fenestrated endoprosthesis of the thoracic aorta, the latter may comprise radiopaque markers 5, preferably arranged at the ends of the main tubular endoprosthesis 1 and / or the free end 31 of the collar 3.

[0095] Thus, the invention makes it possible to optimize the anchoring of the fenestrated endoprosthesis by avoiding the movement of the prosthesis in the direction of the flow.

[0096] This is notably reinforced by: The visible mesh areas (also called free flow in English) at the ends of the prosthesis and at the level of the collar. The first and second stent meshes oriented perpendicular to each other. The length of the prosthesis which is greater than a conventional endoprosthesis (10 to 20 cm for the Gore TAG endoprosthesis for example which is the most used in aneurysms and dissections of the descending thoracic aorta). The collar 3 and the second stent mesh 4 associated with it which tend to deploy against the base of the wall of the supra aortic trunks.

[0097] This fenestrated endoprosthesis makes it possible to overcome a large number of anatomical characteristics of patients which contraindicate endovascular treatment with existing endoprostheses (insufficient diameter of the TSA, insufficient length of the TSA, particular location of the TSA on the aorta, too close relationships of the TSAs between them, etc.).

[0098] The collar 3 and the second stent mesh 4 associated with it make it possible to avoid the creation of aortic legs which make deployment longer and more technical due to the catheterization of the ASD which consists of placing guides in a vessel, and more at risk of major complications, such as strokes.

[0099] This fenestrated stent allows for rapid intervention due to the simplicity of deploying the stent, i.e. less than one hour compared to three to six hours usually.

[0100] Note that the various features, forms, variants and embodiments of the invention may be combined with each other in various combinations to the extent that they are not incompatible or mutually exclusive.

Claims

1. A fenestrated endoprosthesis of the thoracic aorta comprising a first stent meshing (2), a main tubular endoprosthesis (1) made of fabric, said main tubular endoprosthesis being integral with said first stent meshing, and having an arcuate central part (12) configured to be housed in the aortic arch of a patient, said arcuate central part extending between a first end (10) configured to be housed in a portion of the ascending aorta (AA) and a second end (11) configured to be housed in a portion of the descending aorta (AD), characterised in that the fenestrated endoprosthesis of the thoracic aorta further includes a flange (3) also made of fabric and associated with a second stent meshing (4), said flange being substantially frustoconical in shape and provided with a base (30), said base of the flange (3) being fitted over an aperture (13) made on the upper face of the arcuate central part (12) of the main tubular endoprosthesis (1), said flange (3) being configured to be housed at the base of the patient's supra-aortic trunks (TSA).

2. The fenestrated endoprosthesis of the thoracic aorta according to claim 1, characterised in that the second stent meshing (4) mainly consists of a mesh extending over the entire circumference of the flange (3) in substantially sinusoidal or zigzag circumvolutions, the radial force of said meshing making it possible to press the flange (3) against the wall of the base of the supra-aortic trunks (TSA) and thus reduce the risk of endoleaks.

3. The fenestrated endoprosthesis of the thoracic aorta according to claim 1, characterised in that the second stent meshing (4) mainly consists of a plurality of disjointed meshes radially offset from one another, extending over the entire circumference of the flange (3) in substantially sinusoidal or zigzag circumvolutions, the radial force of said meshing making it possible to press the flange (3) against the wall of the base of the supra-aortic trunks (TSA) and thus reduce the risk of endoleaks.

4. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the second stent meshing (4) further includes an elliptical mesh (40) or a mesh defining the contour (40') of a hyperbolic paraboloid surface, at the base (30) of the flange (3), so as to maintain the aperture (13) made on the upper face of the arcuate central part (12) of the main tubular endoprosthesis (1).

5. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the first stent meshing (2) mainly consists of a plurality of disjointed meshes, each extending over the entire circumference of the main tubular endoprosthesis (1) in substantially sinusoidal or zigzag circumvolutions, the radial force of said meshing making it possible to press the main tubular endoprosthesis against the aortic wall and thus reduce the risk of endoleaks, and reinforce the anchoring of the endoprosthesis.

6. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the first stent meshing (2) includes at least one mesh (22) attached to the second stent meshing (4), so as to prevent plications of the main tubular endoprosthesis (1).

7. The fenestrated endoprosthesis of the thoracic aorta according to claim 4, characterised in that the first stent meshing (2) includes at least one mesh (22) attached to the mesh (40, 40') of the base (30) of the flange (3), so as to prevent plications of the main tubular endoprosthesis (1).

8. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that at least one of the ends of the main tubular endoprosthesis (1) or the free end of the flange (3) is an apparent meshing zone (20, 21, 41) devoid of fabric.

9. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the stent meshings are made of a shape memory alloy, preferably a Nickel-Titanium alloy, and the fabric covering the stent meshings is selected from the list defined by braided polyesters, braided Dacron, PTFE.

10. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that it comprises radiopaque markers (5), preferably disposed at the ends of the main tubular endoprosthesis (1) and at the free end (31) of the flange (3).

11. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the first meshing (2) projects onto the flange (3).

12. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that the second meshing (4) projects onto the main tubular endoprosthesis (1).

13. The fenestrated endoprosthesis of the thoracic aorta according to any of the preceding claims, characterised in that a reinforcement (6) extends along the convex face of the arcuate central part (12) of the main tubular endoprosthesis (1), and preferably over the entire length of said main tubular endoprosthesis.

14. The fenestrated endoprosthesis of the thoracic aorta according to the preceding claim, characterised in that the reinforcement is made of nitinol or consists of suture wire on the fabric.