Upside-Down Deployment of the Minos Iliac Limb as a Simple Off-the-Shelf Solution to Overcome Anatomical Limits

Abstract

For isolated internal iliac artery (IIA) aneurysms with tapered anatomy extending from the common iliac artery (CIA) to the external iliac artery (EIA), upside-down deployment of an iliac limb after IIA embolization is a practical alternative. However, conventional techniques for upside-down modifications typically require external removal, inversion, and reinsertion of the stent-graft, which can be cumbersome and time-consuming. This study presents the first report of a simplified upside-down deployment technique that utilizes the Minos iliac limb. After cutting the nose cone, a 12 Fr Minos iliac limb was preloaded in reverse orientation into a 14 Fr sheath, without external manipulation or reloading. Following distal IIA embolization, the stent-graft was deployed by unsheathing to accommodate the tapered anatomy from the CIA to the EIA. This technique provides a streamlined, off-the-shelf solution for anatomically challenging iliac aneurysms and offers an effective alternative when standard deployment methods are not feasible.

Keywords

• endovascular procedures
• iliac artery aneurysm
• stent grafts
• device design