We describe a case of a 72-year-old man, without known cardiovascular risk factors, who was referred to our hospital for new onset worsening angina. ECG on admission showed repolarization abnormalities in anterior leads without a noticeable increase in serum troponin levels. On the basis of clinical and instrumental findings, a coronary angiography was planned. The right femoral approach was intended for the procedure, as it was the standard and preferred access performed in our cathlab. Only a hydrophilic 0.35 in wire (Zip-wire, Boston, USA) was able to the progress along the vessel, due to a tortuosity of the common iliac artery. Not even the placement of a 6 F, 45-cm-long sheath (Arrow-Flex) was able to straighten a wide circular coil. An angiography confirmed this elongation, in a very peculiar shape of a ‘violin key’ (Panel A). It was, anyhow, possible to perform the coronary angiography, and a bare metal stent was implanted in the proximal tract of left anterior descending coronary artery to treat an ulcerated plaque, without complications (Panel B). Total procedural time was 32 min, and radiation dose was 92,657 Gy cm2. Due to a progressive reduction of hemoglobin from 12 g/‌dL to 10 g/dL, in order to exclude a hemorrhage, an angio-CT was performed which excluded any bleeding originating from iliac artery or aorta, and confirmed the wide loop of the common iliac artery (Panels C and ​DD). The contralateral iliac artery appeared only moderately sinuous. The etiology for the sudden drop in hemoglobin was ultimately not found. In our opinion, this occasional finding, neither common nor clinically significant, deserves to be reported because of its originality even though it did not impede to perform the planned coronary angiography. Fig. 1. Panel A: Peripheral angiography showing an elongated and ectatic right common iliac artery, assuming a ‘violin key’ shape. The arrow indicates the tip of a 45-cm-long sheath; Panel B: Angiography after bare metal stent implantation in ...