The use of transradial access for diagnostic and therapeutic interventions has dramatically increased in the recent years and has become the preferred approach for coronary angiography and intervention. The ulnar artery is similar in diameter however is somewhat deeper than the radial artery and adjacent to the ulnar nerve. Although transulnar approach can serve as an alternative strategy it is infrequently taught and rarely (<1%) used. We performed a detailed search and identified all key studies in which the transulnar approach was used (n=3,512). The procedural success of transulnar approach (68-96%) is slightly inferior to the transradial approach in certain centers. The equipment and medications used, safety, efficacy and type of complications observed are similar to transradial interventions. The patient-centered, astute and versatile and interventional cardiologist should master transulnar interventions to better serve is patients. Dedication education and tools (like ultrasound) may further enhance the success rate and popularity of the transulnar approach.