Patient is a 59 y.o. female who presented with lifestyle limiting claudication, infrarenal aortic stenosis and moderate left renal artery stenosis. She has prior bilateral iliac kissing stents that are patent. Percutaneous bilateral common femoral and right radial arterial access were obtained using Seldinger technique. Limited RUE arteriogram was performed. A Glidewire and a pigtail catheter were used to traverse the pararenal aorta. An abdominal aortogram was obtained, which demonstrated a severe stenosis of the left renal artery as well as the 90% heavily calcified stenosis present at the pararenal abdominal aorta and patent right renal. Each renal artery was cannulated from the radial access without difficulty (The Terumo radial to peripheral destination sheath was cut to the appropriate length for cannulation of the right renal artery.) Shock-wave lithotripsy of the infrarenal aorta down to the level of the iliac stents was performed to provide a safer angioplasty and stenting of these lesions. Right renal stent from the radial access and aortic stent from the femoral access were deployed simultaneously at the same level to protect right renal artery patency and allow proximal and distal coverage of the pararenal abdominal aortic stenosis. Repeat arteriography demonstrated that the aortic stenosis had a 0% residual stenosis, as well as a widely patent right renal artery. Shock-wave lithotripsy was then performed on the left renal artery which demonstrated 30% residual stenosis afterwards. All wires and catheters and sheaths were removed and direct pressure was applied for hemostasis upon normalization of ACT.