An endoluminal prosthesis (210 310), such as a stent graft that includes one or more fenestrations (212, 238 312) to accommodate endovascular disease, such as an aneurysm in cases where one or more side branches is involved. In one aspect, the prosthesis includes fenestrations (212 312) that are pivotable to accommodate the dynamic geometry of the aortic branches. In another aspect, the pivotable fenestrations (212 312) include a first perimeter (226 326), a band of flexible material (228 328) attached and surrounding the first perimeter (226 326), and a second perimeter (230 330) attached to and surrounding the band of flexible material (228 328). The first perimeter (226 326), band of flexible material (228 328), and second perimeter (230 330) have a geometric shape. In one aspect, the prosthesis (210 310) includes at least three pivotable fenestrations (212 312).
