Pararenal stent graft

1. A stent graft comprising an elongate tubular body of a biocompatible graft material, the tubular body comprising a distal end and a proximal end, the tubular body comprising a proximal portion of a first selected diameter, a distal portion of a second selected diameter, the second selected diameter being less than the first selected diameter and a tapered central portion between the proximal portion and the distal portion, the tubular body comprising a circumference,

a notional anterior longitudinal datum line on the tubular body and a notional transverse clock face having 12 o'clock at the notional anterior longitudinal datum line;

a scalloped cut out in the proximal portion of the tubular body, the scalloped cut out being open at the proximal end of the tubular body;

a fenestration in the proximal portion, the fenestration being distal of the scalloped cut out;

a first fenestration assembly and a second fenestration assembly in the distal end of the tapered central portion,

the scalloped cut out being circumferentially centered with respect to the notional transverse clock face at 12:30 o'clock, the fenestration in the proximal portion being circumferentially centered with respect to the notional transverse clock face at 12:00 o'clock, the first fenestration assembly being circumferentially centered with respect to the notional transverse clock face at 2:15 o'clock and the second fenestration assembly being circumferentially centered with respect to the notional transverse clock face at 10:00 o'clock.

2. A stent graft as in claim 1 comprising a plurality of self expanding stents affixed along the tubular body.

3. A stent graft as in claim 1 comprising an exposed zig zag self expanding stent extending from the proximal end of the proximal portion.

4. A stent graft as in claim 1 wherein the tapered portion comprises an arcuate side wall whereby the tapered portion comprises an outer face which is concave.

5. A stent graft as in claim 1 wherein the first fenestration assembly comprises a first low profile side arm and the second fenestration assembly comprises a second low profile side arm each of the first and second low profile side arms comprising a proximal external open end.

6. A stent graft as in claim 5 wherein the first and the second low profile side arms each comprise a tubular side branch sealingly received into a side arm fenestration wherein an inner portion of the tubular side branch extends within the tubular body and an outer portion of the tubular side branch extends exteriorly of the tubular body and such that the tubular side branch extends from the tubular body at an angle thereto.

7. A stent graft as in claim 1 wherein each of the first and the second low profile side arms comprises a reinforcement stent and wherein the reinforcement stent comprises a portion of wire forming a first ring and a second ring, the second ring defining a plane which is substantially parallel to and spaced axially apart from the plane of the first ring and at least one wire strut extending between the first ring and the second ring.

8. A stent graft as in claim 5 wherein the stent graft comprises an overall length of approximately 111 mm, the first selected diameter of the proximal portion being 30 mm, the second selected diameter of the distal portion being 20 mm, the proximal portion comprising a longitudinal length of about 39 mm, the distal portion comprising a longitudinal length of about 54 mm, the tapered portion comprising a longitudinal length of approximately 18 mm, the scalloped cut out comprising a circumferential width of about 20 mm and a longitudinal depth of about 19 mm, the fenestration comprising a diameter of 8mm and being centered at a space of 26 mm from the proximal end, external open ends of the first and second low profile side arms each being positioned at a distance of 55mm from the proximal end.

9. A stent graft as in claim 1 wherein the proximal portion of the tubular body comprises a proximally extending bare attachment stent and a first and a second self expanding stent. the first and the second self expanding stents being spaced apart longitudinally, the tapered central portion comprises a single self expanding stent and the distal portion comprises a plurality of self expanding stents.

10. A stent graft as in claim 9 wherein each of the second stent of the proximal portion and the single self expanding stent of the tapered central portion comprise an asymmetric self expanding zig zag stent, each of the asymmetric self expanding zig zag stents comprising a plurality of struts and proximal and distal bends between the struts and a circumference and a part of the circumference comprising bends being spaced circumferentially further apart than others of the bends, thereby defining wider void regions between the bends which are spaced circumferentially further apart.

11. A stent graft as in claim 10 wherein the second stent of the proximal portion is positioned such that the part of the circumference comprising bends being spaced further apart is in an anterior region of the stent graft and the fenestration in the proximal portion is in a wider void region.

12. A stent graft as in claim 10 wherein the single self expanding stent of the tapered central portion is affixed to the stent graft such that the part of the circumference comprising bends being spaced further apart is in an anterior region of the stent graft and the void regions are longitudinally proximal of the first and the second fenestration assemblies.

13. A stent graft as in claim 1 wherein the tapered central portion comprises an asymmetric self expanding zig zag stent, the asymmetric self expanding zig zag stent comprising a plurality of struts and proximal and distal bends between the struts and a circumference and a part of the circumference comprising bends being spaced circumferentially further apart than others of the bends, thereby defining wider void regions between the bends which are spaced circumferentially further apart, the asymmetric self expanding zig zag stent being affixed to the stent graft such that the part of the circumference comprising bends being spaced further apart is in the posterior region of the stent graft and the void regions are longitudinally proximal of the first and the second fenestration assemblies.

14. A stent graft as in claim 6 wherein the tubular side branches are each mounted into the tapered portion by being stitched to the tubular body, the stitching extending circumferentially and diagonally from a proximal end of the tubular side branch to a distal end of the tubular side branch such that the tubular side branch extends from the tubular body at an angle thereto.

15. A stent graft comprising an elongate tubular body of a biocompatible graft material, the tubular body comprising a distal end and a proximal end, the tubular body comprising a proximal portion of a first selected diameter, a distal portion of a second selected diameter, the second selected diameter being less than the first selected diameter and a tapered central portion between the proximal portion and the distal portion, the tubular body comprising a circumference,

a notional anterior longitudinal datum line on the tubular body and a notional transverse clock face having 12 o'clock at the notional anterior longitudinal datum line;

a scalloped cut out in the proximal portion of the tubular body, the scalloped cut out being open at the proximal end of the tubular body;

a fenestration in the proximal portion distal of the scalloped cut out;

a first low profile side arm and a second low profile side arm in the distal end of the tapered central portion, the first and the second low profile side arms each comprising an external open end,

the tapered central portion comprising an asymmetric self expanding zig zag stent, the asymmetric self expanding zig zag stent comprising a plurality of struts and proximal and distal bends between the struts and a circumference and a part of the circumference comprising bends being spaced circumferentially further apart than others of the bends, thereby defining wider void regions between the bends which are spaced circumferentially further apart, the asymmetric self expanding zig zag stent being affixed to the stent graft such that the part of the circumference comprising bends being spaced further apart is in an anterior region of the stent graft and the void regions are longitudinally proximal of the first and the second low profile side arms;

the scalloped cut out being circumferentially centered with respect to the notional transverse clock face at 12:30o'clock and comprising a circumferential width of about 20 mm and a longitudinal depth of about 20 mm,

the fenestration in the proximal portion being circumferentially centered with respect to the notional transverse clock face at 12:00 o'clock and comprising a diameter of 8 mm and being centered at a distance of about 26 mm from the proximal end,

the first low profile side arm being circumferentially centered with respect to the notional transverse clock face at 2:15 o'clock and the second low profile side arm being circumferentially centered with respect to the notional transverse clock face at 10:00 o'clock and proximal ends of each being positioned at a space of 55 mm from the proximal end.