Endovascular aortic aneurysm repair (EVAR) was performed after ultrasound-guided puncture of both common femoral arteries with an aortic-bifurcated endograft (Bolton Treo 36–80 mm, Terumo Aortic, Scotland, UK) prosthesis via an 18F sheath for the main body (
fig. 1). Thereafter, transfemoral TAVI was performed with an ACURATE neo transcatheter heart valve in standard fashion through the aortic stent graft (
fig. 2). The large 18F sheath required for TAVI was carefully advanced under fluoroscopy through the prosthesis to avoid dislodgement of the stent graft. Both procedures were successful, and access was closed using an 18F MANTA device (Essential Medical Inc., Malvern, Pennsylvania, USA,
fig. 3) on both sides. However, a surgical cut-down was needed on one side because of ongoing bleeding. The duration of the procedure was 4 hours and 21 minutes, fluoroscopy time was 31 minutes and a total of 105 ml of contrast was administered. Her further in-hospital course was uneventful with stable kidney function. At 1-month follow-up, there was no endoleak (EVAR), no paravalvular leak and the mean transaortic gradient was 4 mm Hg (TAVI).