A stent graft system includes a stent graft, a radially expandable scaffold, and an inflatable fill structure. The stent graft includes a body portion with a plurality of pleated sections that are configured to be extended from a telescopically compressed state to a longitudinally extended state. The radially expandable scaffold is attached to a top of the body portion, and has one or more fixation elements for penetrating into an aortic wall. The inflatable fill structure is attached at a top of the body portion and is configured to expand in a longitudinal direction as the body portion is extended in the longitudinal direction. The inflatable fill structure is also configured to expand in a radial direction to contact an inner surface of a blood vessel.
