The upside-down zenith stent graft limb

None of the commercially available stent grafts are supplied in a tapered configuration suitable for the endovascular repair of common iliac artery aneurysms. We describe a simple technique for reversing the proximal and distal orientation of a standard flared bell-bottom stent graft limb from the Zenith system of abdominal aortic aneurym repair. When reloaded in this fashion, the stent graft is deployed just like any other Zenith (Cook, Inc., Bloomington, IN) stent graft limb. However, we caution that this departure from standard use introduces new sources of potential device failure, requires several additional precautions, and should not be attempted by those unfamiliar with the routine use of the unmodified device.