Transradial access (TRA) has revolutionized percutaneous vascular procedures by offering reduced bleeding, faster ambulation, and fewer vascular complications compared to transfemoral access. Distal radial access (DRA), particularly from the left side, improves patient and operator ergonomics, is ideal for cannulating bypass grafts, and avoids the tortuosity typical of other approaches. In addition, DRA preserves blood flow in the superficial palmar arch, reducing the risk of proximal radial artery occlusion. Certainly, patient selection requires consideration of factors such as radial pulse quality, absence of prior injury, or surgical intervention, with patients at high risk for bleeding likely to benefit most from DRA. Unfavorable anatomic features at the conventional TRA site, radio-brachial anatomy issues, and patient characteristics should guide the choice of DRA. Furthermore, procedural factors, urgency, operator experience, and equipment limitations should be weighed before attempting DRA. Patient preparation includes optimal arm positioning, which is critical for a successful DRA case. In addition, ultrasound-guided access minimizes puncture attempts and is a recommended practice. Overall, DRA represents an important adaptation of conventional TRA with safety benefits and favorable ergonomics. This chapter provides essential guidance on patient selection, preparation, and procedural factors to enable operators to overcome the challenges and maximize the benefits of DRA.