Common femoral artery puncture for ilio-femoral angioplasty can be hazardous or cumbersome in specific situations that require upper limb access (presence of a hostile groin, previous femoral surgery, cross-over maneuver in the setting of bifurcated aortic graft or pre-existing iliac kissing stents). The brachial artery is an alternative access site that is burdened with significant local complication rates. As in the coronary setting, feasibility and safety of transradial peripheral angioplasty has been reported in the recent literature. Procedural success rates ranged from 87% to 100%. No major access site bleeding was observed. Procedure and fluoroscopy time were not substantially increased, and decreased along with the learning curve. The majority of reports were limited to iliac lesions treatment, due to the lack of long-shaft and dedicated devices. Our experience showed the feasibility of this technique in iliac lesions but also in superficial femoral and popliteal artery procedures. Radial access can be used in situations where femoral approach is unsuitable and as first-line approach in the setting of ambulatory procedures. Although devices evolve, main limitations remain related to the lack of longer introducer sheaths and the absence of specific rescue devices and drug-eluting balloons. As a conclusion, radial access for endovascular ilio-femoral procedures is currently a promising alternative to femoral and humeral access in selected patients with the possibility of same-day discharge, and could progressively be considered when planning peripheral procedures.