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

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.