Fenestrated endoprosthesis for the thoracic aorta

Abstract

The present invention relates to a fenestrated endoprosthesis for the thoracic aorta, comprising a first stent mesh portion 2 and a main tubular endoprosthesis 1 made from fabric, said main tubular endoprosthesis having an arcuate central portion 12 integral with said first stent mesh portion and configured to be received within the aortic arch of a patient, said arcuate central portion extending between a first end 10 and a second end 11, each configured to be received within a portion of the ascending or descending aorta, further comprising a flange 3 made from fabric and joining a second stent mesh portion 4, said flange being substantially frustoconical in shape and comprising a base 30, said base of said flange 3 fitting over an opening 13 made on an upper surface of said arcuate central portion 12, said flange 3 being configured to be received at the base of the superior aortic trunk of a patient.

Description

[Technical field]

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

[0002] An aneurysm is a localized expansion of the arterial wall that occurs when there is a loss of parallelism between the edges of the blood vessel and its size exceeds 1.5 times normal.

[0003] The main risk is rupture of the aneurysm, which usually leads to death.

[0004] Although any artery can be affected, the aorta is most often affected, as it is the largest artery in the human body.

[0005] All aortic aneurysms inexorably grow in size over time, and once the aortic diameter exceeds 5 cm, the risk of rupture becomes significant.

[0006] However, if an aneurysm is detected in time, it is possible to prevent the aneurysm from rupturing by open chest surgery, the signs of which are evident when the diameter exceeds 5.5 cm. However, this type of thoracic surgery is associated with high morbidity and mortality. Since the early 1990s, less invasive treatments have been used for aneurysms of the descending aorta, including the placement of an endoprosthesis through the femoral artery, i.e., endovascular repair.

[0007] Aortic dissection corresponds to a tear in the wall of the aorta, allowing blood to infiltrate the wall and split the wall into two. This creates two passageways. Aortic dissection is a serious condition that affects 3 per 100,000 people. Aortic dissection can affect the ascending aorta, the descending aorta, or both. When aortic dissection affects the ascending aorta, the standard treatment is emergency replacement of the aorta via open chest surgery. For the descending aorta, the standard treatment is medical treatment only. In cases of complications, endovascular treatment using an endoprosthesis is performed.

[0008] The endoprosthesis is a stent (i.e., a mesh-like tubular metal device commonly known as a "spring") that is combined with a sealing wall (a "stent-graft" or in French "covered stent") and expanded inside the artery at the site of the aneurysm. The endoprosthesis separates the aneurysm from the blood flow and recreates a cylindrical arterial segment at the location of the endoprosthesis.

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

[0010] Endovascular treatment of aneurysms and descending aortic dissections has become the standard of care.

[0011] However, for the ascending aorta, open surgery remains the standard of care, mainly due to the anatomical complexity of the segment: the aorta is a hook-shaped structure surrounded by substantial vessels that cannot tolerate occlusion: the coronary ostia and the supra-aortic trunks that form the vasculature of the brain.

[0012] WO 2007 / 028086 describes a thoracic endoprosthesis that fits into the aortic arch due to the presence of "fenestrations" in the wall of the stent facing three vessels; these fenestrations allow the passage of blood through the prosthesis and thus the vascularization of the vessels going to the head, neck and arms.

[0013] However, the insertion of this stent is a difficult operation, since it must be ensured that it does not rotate during insertion, otherwise the fenestration will not be located facing the blood vessel, which may result in total or partial occlusion and death of the patient.

[0014] In addition, the procedure to place an endoprosthesis still requires 3-5 hours of surgery, which is a demanding operation under general anesthesia. The complexity of the procedure means that it must be performed in a specialized center by an experienced surgeon, thus limiting the availability and mass adoption of the procedure.

[0015] This procedure requires the placement of guides into the blood vessels of the neck and is therefore associated with a high risk of cerebrovascular accident (CVA). There is also the problem of placing the endoprosthesis to prevent it from migrating in the direction of blood flow.

[0016] Finally, these types of endoprostheses need to be custom fabricated from the patient's CT scan, therefore entailing long delivery times (average one month) and making them unsuitable for the emergency treatment of such conditions.

[0017] WO 2011 / 041773 A1 relates to an endoprosthesis in which two side branches are inserted into the superior aortic trunk. This type of endoprosthesis also needs to be custom-made from the patient's CT scan and requires a significantly longer operation time to place in the patient's body, since the branches also need to be inserted into the superior aortic trunk. The complexity of this procedure limits the widespread use and mass adoption of this treatment, since it requires implantation by skilled surgeons in specialized centers.

[0018] US Patent Application Publication No. 2011 / 270380 A1 describes an endovascular prosthesis that includes a tubular body and an outer connection portion expandable relative to the tubular body from a collapsed configuration to a deployed position.

[0019] As with previous literature, this type of endoprosthesis requires custom design and long surgical time due to its branches. The complexity of the procedure requires implantation by skilled surgeons in specialized centers, limiting the widespread use and mass adoption of this treatment. Summary of the Invention [Problem to be solved by the invention]

[0020] To this end, it is an object of the present invention to enable treatment at the thoracic level for aneurysms and dissections of the ascending aorta, including the aortic arch, with maximum safety, while reducing the complexity of the surgical procedure. [Means for solving the problem]

[0021] More particularly, one aspect of the invention is a fenestrated endoprosthesis for the thoracic aorta comprising a first stent mesh portion and a main tubular endoprosthesis made from fabric. 1. A fenestrated thoracic aortic endoprosthesis, wherein the main tubular endoprosthesis is integral with the first stent mesh portion and has an arcuate central portion configured to be received within the aortic arch of a patient, the arcuate central portion extending between a first end configured to be received within a portion of the ascending aorta and a second end configured to be received within a portion of the descending aorta, the thoracic aortic endoprosthesis further comprising a flange also made from fabric and mating with the second stent mesh portion, the flange being substantially frustoconical in shape and having a base, the base of the flange fitting over an opening made on an upper surface of the arcuate central portion of the main tubular endoprosthesis, the flange being configured to be received at the base of the superior aortic trunk of a patient.

[0022] Optional, additional or alternative features of the invention are set out below.

[0023] According to some features, the second stent mesh portion is primarily composed of mesh, the mesh extending around the entire circumference of the flange in a substantially sinusoidal spiral manner, and a radial force of the mesh portion can press the flange against the wall of the base of the superior aortic trunk, thus enabling a reduction in the risk of endoleak.

[0024] According to another feature, the second stent mesh portion is mainly composed of a plurality of discrete meshes which are radially offset from one another and extend around the entire circumference of the flange in a substantially sinusoidal spiral manner, and a radial force of the mesh portion presses the flange against the wall of the base of the superior aortic trunk, thus enabling a reduction in the risk of endoleaks.

[0025] According to another feature, the second stent mesh portion may further include an elliptical mesh or a mesh defining the contour of a hyperbolic paraboloid at the base of the flange so as to maintain the opening created on the upper surface of the arcuate central portion of the main tubular endoprosthesis.

[0026] According to other further features, the first stent mesh portion is primarily comprised of a plurality of discrete meshes, each of the plurality of discrete meshes extending circumferentially around the entire circumference of the main tubular endoprosthesis.

[0027] According to another further feature, the first stent mesh portion can include at least one mesh attached to the second stent mesh portion so as to prevent folding of the main tubular endoprosthesis, which corresponds to wrinkles formed by the body of the endoprosthesis if the endoprosthesis is deployed incorrectly or if there is significant external stress, and which can result in anything from poor blood flow due to simple stenosis to occlusion of the prosthesis.

[0028] According to other further features, the first stent mesh portion can include at least one mesh attached to the mesh at the base of the flange to prevent collapse of the main tubular endoprosthesis.

[0029] Advantageously, at least one of the ends of the main tubular endoprosthesis or the free end of the flange may be a fabric-free, apparently mesh-forming area.

[0030] The fabric covering the stent mesh portion may preferably be selected from the list defined by braided polyester, braided Dacron, PTFE.

[0031] Desirably, the stent mesh portion may be made from a shape memory alloy, preferably a nickel titanium alloy.

[0032] Advantageously, the fenestrated endoprosthesis of the thoracic aorta is provided with radiopaque markers, which may preferably be arranged at both ends of the main tubular endoprosthesis and / or at the free ends of the flanges.

[0033] According to one particular embodiment, the first stent mesh portion may protrude above the flange.

[0034] According to other particular embodiments, the second stent mesh portion may protrude over the main tubular endoprosthesis.

[0035] Advantageously, a reinforcement portion may extend along the convex surface of the arcuate central portion of the main tubular endoprosthesis, preferably over the entire length of the main tubular endoprosthesis.

[0036] Preferably, the reinforcement is made from Nitinol or suture wire.

[0037] Further advantages and features of the invention will become apparent on reading the detailed description of the implementations and non-limiting embodiments and the accompanying drawings below. [Brief description of the drawings]

[0038] [Figure 1] 1 is a schematic side view of a thoracic endoprosthesis, in accordance with one particular embodiment of the present invention. [Diagram 2] 1 is a schematic side view of a thoracic endoprosthesis positioned within a patient's aortic arch, in accordance with one particular embodiment of the present invention. [Diagram 3] 1 is a schematic top view of a thoracic endoprosthesis, according to one particular embodiment of the invention. [Figure 4] 1 is a schematic side view with dimensions of a thoracic endoprosthesis according to the present invention; [Diagram 5] 1 is a schematic, dimensional top view of a thoracic endoprosthesis according to the present invention; FIG. [Figure 6] 1 is a schematic side view of the aortic arch of a patient fitted with a thoracic endoprosthesis in accordance with one particular embodiment of the present invention. [Figure 7] 1 is a schematic side view of a thoracic endoprosthesis according to one particular embodiment of the invention. [Figure 8] 1 is a schematic top view of a thoracic endoprosthesis according to one particular embodiment of the invention. [Figure 9] 1 is a schematic side view of a thoracic endoprosthesis positioned in the aortic arch of a patient, in accordance with one particular embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0039] The embodiments described below are in no way limiting, and alternatives to the present invention that include only a selection of the described features, isolated from other features described, are possible if the selection of the features is sufficient to provide a technical advantage or to distinguish the present invention from prior art information, even if the selection is isolated from a sentence that includes these other features.

[0040] This selection includes at least one feature, preferably a functional feature without structural details, or a feature with some structural details, provided that only this part confers a technical advantage or distinguishes the invention from prior art information.

[0041] According to the invention, as shown in Figures 1 and 6, a fenestrated endoprosthesis for the thoracic aorta comprises a first stent-mesh portion 2 and a main tubular endoprosthesis 1 made from a biocompatible fabric forming a sealing jacket, recreating a cylindrical vessel and isolating the sac formed by the aneurysm from the blood circulation.

[0042] The main tubular endoprosthesis has an arcuate central portion 12 configured to be received within a patient's aortic arch. The arcuate central portion 12 extends between a first end 10 configured to be received within a portion of the ascending aorta AA and a second end 11 configured to be received within a portion of the descending aorta AD.

[0043] Advantageously, the fabric constituting the main tubular endoprosthesis may be chosen from the list defined by braided polyester, braided Dacron, and PTFE.

[0044] The fabric may be, for example, PTFE such as Teflon® or Dacron®, materials commonly used in simple endoprostheses.

[0045] Furthermore, the outer diameter and length of the expanded main tubular endoprosthesis are advantageously selected to be between 25 and 60 mm and between 180 and 450 mm, respectively. These dimensions make it possible to perfectly adapt the main tubular endoprosthesis 1 to the morphology of the aortic arch (also known as the transverse aorta) of the patient.

[0046] However, the invention is not limited to specific dimensions or materials, as those skilled in the art are able to adapt it to individual cases.

[0047] In accordance with the present invention, the main tubular endoprosthesis 1 includes an opening 13 on the upper surface of its arcuate central portion 12 .

[0048] By "superior surface" is meant the convex portion of arcuate central portion 12, i.e., the convex portion facing the base of the superior aortic trunk.

[0049] According to the invention, the fenestrated thoracic aortic endoprosthesis further comprises a flange 3 which is also made from fabric and which joins with a second stent mesh section 4 .

[0050] The flange 3 is configured to be received at the base of the patient's trunk of the superior vena cava (TSA).

[0051] "Accommodated at the base of the superior aortic trunk" means that the flange faces the superior aortic trunk and therefore does not insert into the superior aortic trunk.

[0052] It is the precise location of the flange in the aorta that allows for the "universality" of the endoprosthesis as well as the simplicity and speed of implantation.

[0053] The flange 3 is substantially frusto-conical in shape, the base of which is substantially elliptical.

[0054] The base of the flange may advantageously also define the contour of a hyperbolic paraboloid. This shape allows the widest possible opening of the flange, making it adapt to most anatomical variations of the superior aortic trunk. In other words, the three-dimensionality of the hyperbolic paraboloid allows the maximum widening of the opening 13 in the three planes of space, i.e. anterior-posterior, lateral, superior-inferior. Advantageously, the dimensions of the major axes of the base and apex of the frustoconical flange 3 are chosen to be between 50 and 150 mm and between 50 and 130 mm, respectively, to perfectly adapt to the morphology of the aortic arch of the patient.

[0055] Similarly, the dimensions of the short axes of the base and apex of the frusto-conical flange 3 are selected to be between 25 and 60 mm and between 10 and 50 mm, respectively, to perfectly match the morphology of the patient's aortic arch.

[0056] The frusto-conical flange 3 preferably extends for a length between 8 and 40 mm.

[0057] However, the invention is not limited to specific dimensions or materials, as a person skilled in the art can adapt it to each case.

[0058] The base of the flange 3 fits over an opening 13 made on the upper surface of the arcuate central portion 12 of the main tubular endoprosthesis 1 .

[0059] By fitted it is meant that the flange 3 is attached to the main tubular endoprosthesis at the opening 13 .

[0060] The assembly formed by the main tubular endoprosthesis and the flange may be fabricated as a single integral piece, for example by 3D printing.

[0061] Alternatively, the flange 3 can be sewn to the main tubular endoprosthesis 1 by bonding or sewing, for example an opening 13 is drilled in the main tubular endoprosthesis 1 before suturing. The suture must ensure a seal of the joint between the main tubular endoprosthesis 1 and the flange 3.

[0062] The flange 3 is preferably made of the same fabric as the main tubular endoprosthesis 1 .

[0063] The main tubular endoprosthesis 1 is joined to a first stent mesh portion 2 in that the first stent mesh portion is typically attached to the outer surface of the main tubular endoprosthesis, such that said stent mesh portion maintains the main tubular endoprosthesis in its required shape.

[0064] Other non-limiting configurations of the stent mesh portion being embedded within the fabric or disposed against the inner surface of the main tubular endoprosthesis 1 are also contemplated.

[0065] Preferably, the stent mesh portion is made from a shape memory alloy, for example a nickel titanium alloy, in particular Nitinol.

[0066] According to other non-limiting configurations, the stent mesh portion can be Z-stents™, made, for example, from an alloy of chromium and cobalt.

[0067] Advantageously, the first stent mesh portion 2 is mainly composed of a plurality of separate meshes, each of which extends circumferentially over the entire circumference of the main tubular endoprosthesis 1 .

[0068] Preferably, the meshes may extend in a substantially sinusoidal or zigzag spiral such that the meshes deform like a spring.

[0069] Thus, the radial force of the mesh presses the main tubular endoprosthesis 1 against the aortic wall, making it possible to reduce the risk of endoleaks.

[0070] According to other non-limiting configurations, the stent mesh sections may be connected in pairs by a number of connecting means, which may be the subject of many embodiments, but may generally consist of a metal rod (e.g. made of chrome-cobalt alloy or even Nitinol) that is fixed at its two ends to the structure of the stent mesh sections, for example by loops or hooks that encircle the stent mesh sections.

[0071] As regards the flange 3, this is joined to a second stent mesh portion 4 in that the second stent mesh portion is typically attached to the outer surface of the flange, such that the stent mesh portion maintains the flange in its required shape.

[0072] Other non-limiting configurations of the stent mesh portion being embedded within the fabric or disposed against the inner surface of the main tubular endoprosthesis 1 are also contemplated.

[0073] Preferably, the second stent mesh portion 4 consists essentially of a single mesh extending around the entire circumference and length of the flange 3 .

[0074] Preferably, the mesh extends in a substantially sinusoidal or zigzag spiral such that the mesh deforms like a spring.

[0075] Thus, the radial force of the second stent-mesh section 4 presses the flange 3 against the proximal wall of the superior aortic trunk TSA, allowing a reduction in the risk of endoleaks.

[0076] As shown in Figures 2 and 6, it can be seen that the wall of the base of the superior aortic trunk TSA has a tendency to apply pressure to the flange 3, and the flange 3 applies counter pressure to the wall of the base of the superior aortic trunk by the second stent mesh portion 4.

[0077] According to an alternative embodiment, the second stent mesh part 4 is mainly composed of two separate meshes radially offset from each other so as to reinforce the support of the flange created by the two stent meshes.

[0078] Preferably, the second stent mesh portion is made from a shape memory alloy, for example a nickel titanium alloy, in particular Nitinol.

[0079] According to other non-limiting configurations, the stents can be Z-stents™, made, for example, from an alloy of chromium and cobalt.

[0080] Advantageously, the second stent mesh portion 4 may further comprise an elliptical mesh 40 at the base 30 of the flange 3 so as to maintain the openings 13 made on the upper surface of the arcuate central portion 12 of the main tubular endoprosthesis 1 .

[0081] For the same purpose, the second stent mesh portion 4 may further comprise a mesh 40' defining the contour of a hyperbolic paraboloid.

[0082] Also advantageously, the first stent mesh portion 2 can further comprise at least one mesh 22 attached to the second stent mesh portion 4 so as to prevent the main tubular endoprosthesis 1 from collapsing.

[0083] This mesh 22 is preferably attached to an elliptical mesh 40 or a mesh 40' defining the contour of a hyperbolic paraboloid at the base 30 of the flange 3 so as to prevent the main tubular endoprosthesis 1 from collapsing.

[0084] As shown in Figures 7, 8 and 9, in order to keep the flange 3 as vertical as possible and therefore prevent the flange 3 from collapsing, the first stent mesh portion 2 advantageously protrudes over the flange 3 beyond portion 24 of the flange to reinforce the deployment of the flange against the superior aortic trunk.

[0085] More specifically, some meshes of the first mesh portion extend to the flange to form an incomplete circle. The presence of these meshes restricts the second mesh portion onto the flange, thus allowing the overall size of the fenestrated endoprosthesis to be reduced. In this way, the endoprosthesis is miniaturized, allowing the use of smaller diameter launchers that can be introduced into the smaller sized femoral artery.

[0086] Naturally, as an alternative, and for the same purpose and according to the same principle, a second stent mesh section 4 also projects onto the main tubular endoprosthesis 1 .

[0087] Advantageously, a reinforcement 6 extends along the convex surface of the arcuate central portion 12 of the main tubular endoprosthesis 1, preferably over the entire length of the main tubular endoprosthesis. This reinforcement thus makes it possible to avoid "accordion" type folding in the longitudinal direction, thus facilitating the deployment of the endoprosthesis over its entire length.

[0088] This reinforcement 6 can for example be made of Nitinol or consist of suture wire on the fabric.

[0089] To facilitate anchoring of the main tubular endoprosthesis, one of the ends of the main tubular endoprosthesis may be a fabric-free, apparently mesh-forming area 20, 21, which is referred to as "free flow."

[0090] Similarly, the free end 31 of the flange 3 may be a mesh-forming area 41 that is apparently devoid of fabric.

[0091] These apparently mesh-forming regions 20, 21 and 41 are in fact composed of meshes extending in a substantially sinusoidal or zigzag spiral, where the apexes of the sinusoids or zigzags may be closer together or further apart along a radial direction, which is perpendicular to the direction corresponding to the flow of blood flow.

[0092] These apparent mesh-forming areas 20, 21 and 41 extend for a distance of 20 mm or less.

[0093] The apexes can come together radially when the fenestrated endoprosthesis is placed within the thoracic aorta by the cone and delivery guide.

[0094] Once positioned within the aorta, the mesh has the tendency to return to its original shape, with the apices radially detaching and remaining within the wall of the ascending aorta AA, the wall of the descending aorta AD, and the wall of the base of the superior aortic trunk TSA.

[0095] To facilitate insertion of the fenestrated endoprosthesis of the thoracic aorta, the fenestrated endoprosthesis of the thoracic aorta may preferably be provided with a radiopaque marker 5 disposed at the end of the main tubular endoprosthesis 1 and / or at the free end 31 of the flange 3.

[0096] Thus, the present invention allows for optimization of the placement of a fenestrated endoprosthesis by preventing migration of the fenestrated endoprosthesis in the direction of blood flow.

[0097] This is reinforced, in particular, by: - apparent mesh-forming areas at the ends of the prosthesis and at the flanges (also called free flow). - a first stent mesh portion and a second stent mesh portion oriented perpendicular to each other. - An endoprosthesis length greater than that of conventional endoprostheses (eg, 10 to 20 cm for the Gore TAG endoprosthesis, which is most commonly used for aneurysms and dissections of the descending thoracic aorta). The flange 3 and the second stent mesh portion 4 which is connected to the flange 3 have the property of deploying against the base of the wall of the superior aortic trunk.

[0098] This fenestrated endoprosthesis makes it possible to overcome a number of patient anatomical features that contraindicate endovascular treatment with existing endoprostheses (insufficient TSA diameter, insufficient TSA length, specific location of the TSA on the aorta, TSAs too closely related to each other, etc.).

[0099] The flange 3 and the second stent mesh section coupled to the flange 3 make it possible to avoid the creation of aortic struts, which take longer to deploy, require more skill, and pose a higher risk of serious complications such as cerebrovascular accidents, for the catheter insertion into the TSA consisting of placing the guide in the blood vessel.

[0100] This fenestrated endoprosthesis allows for rapid intervention because of the ease with which the endoprosthesis can be deployed, less than one hour compared to the usual three to six hours.

[0101] It should be noted that different features, features, alternatives and embodiments of the invention can be combined with each other in various combinations, unless they are incompatible or mutually exclusive.

Claims

**Claim 1** A fenestrated endoprosthesis for the thoracic aorta, comprising a first stent mesh portion (2) and a main tubular endoprosthesis (1) made of fabric, wherein the main tubular endoprosthesis is integral with the first stent mesh portion and has an arcuate central portion (12) configured to be received within the aortic arch of a patient, the arcuate central portion extending between a first end (10) configured to be received within a portion of the ascending aorta (AA) and a second end (11) configured to be received within a portion of the descending aorta (AD). In the fenestrated endoprosthesis for the thoracic aorta, the fenestrated endoprosthesis for the thoracic aorta is also made of fabric and further includes a flange (3) coupled to a second stent mesh portion (4), the flange having a substantially frustoconical shape and a base (30), the base of the flange (3) being fitted onto an opening (13) made on the upper surface of the arcuate central portion (12) of the main tubular endoprosthesis (1), and the flange (3) being configured to be received at the base of the patient's upper aortic trunk (TSA). **Claim 2** The second stent mesh portion (4) is mainly composed of a mesh, the mesh extending in a substantially sinusoidal or zigzag spiral state over the entire circumference of the flange (3), and the radial force of the mesh portion pressing the flange (3) against the wall of the base of the upper aortic trunk (TSA), thus enabling reduction of the risk of endoleak. The fenestrated endoprosthesis for the thoracic aorta according to claim 1. **Claim 3** The second stent mesh portion (4) is mainly composed of a plurality of separate meshes, the plurality of separate meshes being radially offset from each other and extending in a substantially sinusoidal or zigzag spiral state over the entire circumference of the flange (3), and the radial force of the mesh portion pressing the flange (3) against the wall of the base of the upper aortic trunk (TSA), thus enabling reduction of the risk of endoleak. The fenestrated endoprosthesis for the thoracic aorta according to claim 1. **Claim 4** The second stent mesh portion (4) further includes an elliptical mesh (40) or a mesh (40') defining a hyperbolic paraboloid outer shape on the base (30) of the flange (3) so as to maintain the opening (13) formed on the upper surface of the arcuate central portion (12) of the main tubular inner prosthesis (1). The fenestrated inner prosthesis for the thoracic aorta according to claim 1, characterized in that.

5. The first stent mesh portion (2) is mainly composed of a plurality of separate meshes, and each of the plurality of separate meshes extends on the entire circumference of the main tubular inner prosthesis (1) in a substantially sinusoidal or zigzag spiral state. The radial force of the mesh portion presses the main tubular inner prosthesis against the aortic wall, thus reducing the risk of endoleak and enabling reinforcement of the placement of the inner prosthesis. The fenestrated inner prosthesis for the thoracic aorta according to claim 1, characterized in that.

6. The first stent mesh portion (2) includes at least one mesh (22) attached to the second stent mesh portion (4) so as to prevent folding of the main tubular inner prosthesis (1). The fenestrated inner prosthesis for the thoracic aorta according to claim 1, characterized in that.

7. The first stent mesh portion (2) includes at least one mesh (22) attached to the meshes (40, 40') of the base (30) of the flange (3) so as to prevent folding of the main tubular inner prosthesis (1). The fenestrated inner prosthesis for the thoracic aorta according to claim 4, characterized in that.

8. At least one of the ends of the main tubular inner prosthesis (1) or the free end of the flange (3) is a seemingly mesh-forming area (20, 21, 41) without cloth. The fenestrated inner prosthesis for the thoracic aorta according to claim 1, characterized in that.

9. The stent mesh portion is made of a shape memory alloy, preferably a nickel-titanium alloy, and the cloth covering the stent mesh portion is selected from the list defined by braided polyester, braided dacron, and PTFE. The fenestrated inner prosthesis for the thoracic aorta according to claim 1, characterized in that.

10. The fenestrated endovascular prosthesis described above comprises a radiopaque marker (5), and the radiopaque marker (5) is preferably disposed at both ends of the main tubular endovascular prosthesis (1) and at the free end (31) of the flange (3). The fenestrated endovascular prosthesis for the thoracic aorta according to claim 1 is characterized by this.

11. The fenestrated endovascular prosthesis for the thoracic aorta according to claim 1 is characterized in that the first stent mesh portion (2) protrudes on the flange (3).

12. The fenestrated endovascular prosthesis for the thoracic aorta according to claim 1 is characterized in that the second stent mesh portion (4) protrudes on the main tubular endovascular prosthesis (1).

13. The fenestrated endovascular prosthesis for the thoracic aorta according to claim 1 is characterized in that a reinforcing portion (6) extends along the convex surface of the arcuate central portion (12) of the main tubular endovascular prosthesis (1), preferably over the entire length of the main tubular endovascular prosthesis.

14. The fenestrated endovascular prosthesis for the thoracic aorta according to claim 13 is characterized in that the reinforcing portion is made of nitinol or composed of suture wires on the cloth.

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