An endoluminal prosthesis (200) comprises a graft having a tubular body comprising proximal and distal ends, and a valve replacement (260) disposed between the proximal and distal ends of the graft. At least one stent (216a) is coupled to the graft and has a contracted delivery state and an expanded state for maintaining patency within a portion of the graft. At least one fenestration (212a, 212b) is disposed in a sidewall of the graft at a location distal to the valve replacement. The at least one fenestration may be pivotable in any direction away from an axis perpendicular to a longitudinal axis of the prosthesis.
