(A) Severe tortuosity of aortic arch (arrow) that required navigation. (B) Significant and important reduction in aortic arch tortuosity with introduction of Lunderquist wire (arrow) (Cook Medical, Bloomington, IN, USA). (C) Successful deployment of 20 mm Sapien Ultra RESILIA Edwards balloon expandable valve (Edwards Lifesciences Corporation, Irvine, CA, USA) fully deployed (arrow). (D) Final angiogram demonstrating patent left iliofemoral system after removal of wires and sheaths and surgical closure of arteriotomy, and pseudostenosis of right external iliac system (arrow) with just a 6F Pigtail catheter.