Transradial access (TRA) is widely recognized for its safety and efficacy in percutaneous procedures. However, radial artery occlusion and ergonomic challenges, particularly on the left side, remain important concerns. Distal radial access (DRA) has emerged as an alternative approach that adequately addresses these limitations. It preserves forearm radial artery flow, reduces hemostasis time, and offers improved left-side access. In addition, DRA provides additional puncture sites, thereby minimizing recurrent radial artery injury. Secondary DRA is a valuable strategy for patients undergoing multiple transradial procedures, reducing the impact of repeated radial artery punctures, even in complex situations. Ancillary DRA is compatible with transradial arterial lines to ensure the safety benefits of transradial access. Dual access techniques such as BUSHI DO and OTRANTO offer unique solutions for complex procedures where safety is paramount. The experimental advantages of DRA in maintaining forearm radial artery patency underscore its role in preserving radial artery flow. In unfavorable hand anatomies, careful preprocedural assessment, ultrasound guidance, and fluoroscopy are further essential. This chapter shows that DRA is a safe and valuable alternative to TRA, with opportunities to overcome limitations and expand its applications. Proper knowledge and experience are key to unlocking the full potential of DRA in interventional practice.