Although obtaining non-femoral same-limb dual-arterial access had been reported by Biondi-Zoccai et al.  in 2011 yet until recently there were only few sparse mentions of it scattered in the literature. Recently Kumar et al.  documented their experience, where none of the 16 patients with single extremity dual arterial cannulation for cardiac catheterization lost their arterial patency at 1 week follow-up. However, as described in their article and also in our experience, this fear of losing limb perfusion altogether can be allayed by taking precaution in the form of selecting patients with adequate palmer collateral network, screening for peripheral arterial insufficiency, avoiding arterial dissection while obtaining wire access, optimal use of peri-procedural anti-thrombotic therapy, reducing procedure time, proper and frequent flushing of sheaths, early sheath removal using patent haemostasis technique and using smaller, hydrophilic coated, tapered-tip introducer sheaths maintaining optimal sheath-to-artery ratio e.g., Glidesheath slender® (Terumo medical corp, New Jersey, USA).
Safety and feasibility of obtaining a homolateral ulnar approach in cases of radial approach failure have already been demonstrated in a prospective multicentre European registry wherein same-limb ulnar access was obtained successfully in 85.7% of patients having failed radial cannulation without any evidence of early limb ischemia . Another modification which can be employed to avoid risking arm ischemia is to cannulate distal radial artery instead of proximal main radial artery as it prevents proximal arterial occlusion and does not jeopardizes hand circulation with simultaneous ulnar artery access ensuring successful passage as it is of relatively larger bore, less tortuous, devoid of loops and has relatively straighter course less liable for arterial spasm [4,5,6,7,8]. Vascular access-site complications viz. spasm, tortuosity, perforations, pseudoaneurysms and functional occlusions need expertise of competent invasive vascular specialists, if encountered while obtaining same-limb dual-arterial access.