Percutaneous aortic valve implantation procedures in non-operable patients have been developed and applied worldwide for since, avoiding open-heart surgery.The aortic valve prosthesis is generally delivered percutaneously via a specific catheter based technique and implanted within the diseased aortic valve.The procedure is performed under local (or general) anaesthesia without cardiac assistance.The gold standard pathway is the femoral artery.However, alternative pathways have been developed in patients with peripheral arterial disease.Although, trans apical or subclavian are the most commonly used, carotid arteries or trans-ascending aorta implantations were accomplished successfully.We here develop our extensive experience with this technology, using the above mentioned possibilities, based on the characteristics of the available devices (COREVALVE, Medtronic and SAPIENS Edwards).Where appropriate, reference will be made to alternative technologies.