An 87-year-old woman with symptomatic severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI). Multi-detector computed tomography showed a significantly tortuous descending thoracic aorta (Figure 1A and B). Due to the high risk of coronary obstruction and a horizontal aorta, a SAPIEN 3 (Edwards LifeSciences, Irvine, CA, USA) prosthesis via transfemoral access was considered. However, the total length of the Edwards expandable introducer sheath (eSheath, 360 mm) was not sufficient to reach the acute bend in the thoracic aorta, which measured 415 mm in length. Therefore, direct right common iliac access obtained by retroperitoneal approach was chosen to insert the eSheath beyond the acute bend of the thoracic aorta (Figure 1C and D). After insertion of a single stiff wire, the tip of the eSheath was successfully placed beyond the acute bend of the thoracic aorta with no resistance (Figure 1E). Using buddy wire technique, smooth delivery and implantation of a 26-mm SAPIEN 3 was successful without vascular complication (Figure 1F-H).