Purpose <p>Trans-radial access (TRA) offers advantages in elective settings, but its safety and feasibility in emergencies remain understudied. This study compares TRA and trans-femoral access (TFA) in emergency embolizations at a Level 1 trauma center.</p> Materials and Methods <p>Ethical approval was obtained for this retrospective analysis. A total of 421 emergency embolizations performed on 389 patients were included. TRA (n = 95, including 44 distal radial) and TFA (n = 326) were compared for technical success rate, procedural success rate, and access-site complications. Multivariate analysis was used to identify independent predictors of complications.</p> Results <p>TRA patients were younger (median 58 vs. 66&#xa0;years; <i>p</i> = 0.044) with less hypertension (33.7% vs. 46.6%; <i>p</i> = 0.025). Technical success rate was 99.0% for TRA and 99.7% for TFA (<i>p</i> = 1.000). Procedural success was 100% for TRA and 99.7% for TFA (<i>p</i> = 1.000). Overall complications occurred in 5.5% (3.2% TRA vs. 6.1% TFA; <i>p</i> = 0.234), most were minor bleeding-related complications (2.1% TRA vs. 5.2% TFA; <i>p</i> = 0.164). Major complications (1.0% total) included pseudoaneurysm formation (n = 3; 1 in TRA, 2 in TFA) and retroperitoneal hemorrhage (n = 1 in TFA), with no group differences (<i>p</i> = 0.908). Adjusting for age, hypertension, diabetes mellitus, antithrombotic use and sheath size, multivariate analysis found that access site (TRA vs. TFA) was not found to be an independent predictor of all complications (OR 0.524; 95% CI: 0.147&#xa0;–&#xa0;1.859; <i>p</i> = 0.317).</p> Conclusion <p>TRA, including distal radial “snuffbox” access, is a safe alternative to TFA for emergency embolization, demonstrating high technical and procedural success rates.</p> Level of Evidence <p>Level 4, Cohort study.</p> Graphical Abstract <p></p>