Dr. Gruentzig first reported percutaneous endoluminal coronary angioplasty in 1977. With the continuous development in the past 30 years, nowadays, no matter the surgical equipment, medical level, or perioperative drug treatment are becoming more and more perfect, and coronary angiography and endoluminal coronary angioplasty have become a major means of diagnosis and treatment of coronary heart disease. Since coronary intervention is a minimally invasive technique that involves catheterization through a vascular pathway, it is crucial to establish effective vascular access. The traditional route is usually the femoral artery, since 1989, Dr. Jampeau first reported percutaneous radial artery puncture for coronary angiography, transradial artery route has been gradually adopted by doctors in many countries and regions around the world. In recent years, the advantages and disadvantages of the radial and femoral routes have become one of the hot topics of debate. The femoral artery has a relatively large internal diameter, is not prone to spasm, is easy to operate and has a high success rate of puncture, and it is easy to change the instruments during the operation, and it is possible to choose a thicker sheath to improve the success rate of the operation, and the method of puncture is simple, and it is easy for the operator to master the technique of femoral artery puncture, and it has become the most commonly used vascular pathway in cardiac catheterization laboratories of various hospitals. However, due to the deeper anatomical part of the femoral artery, it is more difficult to compress the puncture point to stop bleeding after surgery, so it will inevitably expose some of its own shortcomings. For example, it is prone to subcutaneous hematoma, hemorrhage, pseudoaneurysm or arteriovenous fistula, skin ulceration; damage to the nerves resulting in limb pain; some patients experience severe vagal reflexes during local compression, resulting in bradycardia and hypotension; inappropriate puncture resulting in retroperitoneal hematoma; lower extremity braking resulting in decreased comfort (back pain) or urinary difficulties, and so on. The incidence of all types of complications of femoral artery puncture is about 2%, but serious fatal complications are rare. Therefore, patients do not need to be overly anxious about femoral artery puncture, and do not need to be overly nervous once it occurs, as most complications will not leave sequelae through timely treatment. According to the author’s experience, heparin-free imaging can be performed via the femoral artery route, and immediate postoperative extubation can significantly reduce the puncture complications caused by delayed extubation. At the same time, it is also crucial to improve the responsibility of clinicians, timely detection, timely treatment and mastery of the method of dealing with complications. For example, our hospital has successfully treated four patients with pseudoaneurysms using the minimally invasive method of intra-aneurysm injection of thrombin, which avoided skin breakdown and infection caused by prolonged compression of the puncture point, ischemia of the lower limbs or sending them to surgery for repair. New devices have also emerged in recent years, such as vascular sealers and femoral artery-specific hemostatic valves, which can effectively stop bleeding and shorten patients’ bedtime after surgery. The femoral route is particularly important in complex coronary artery lesions that may require strong catheter support or a thicker guiding catheter, in which case the femoral route is often irreplaceable. Therefore, both physicians and patients should not blindly pursue the radial artery route, which may result in bad outcomes or surgical failure. The palm of the human hand has a dual blood supply from the radial and ulnar arteries through collateral circulation, so the vast majority of patients can be cannulated through the radial artery without causing ischemia in the hand. However, 10% of patients may have incomplete establishment of collateral circulation, which may cause severe ischemia or even necrosis of the hand once the radial artery is punctured. Therefore, it is crucial to check the blood supply to the palm before the operation, and interventionalists usually perform the Allen’s test on the patients to check whether the collateral circulation of the palm is good or not. Since the radial artery is not surrounded by important blood vessels or nerves and is relatively superficial, the inherent advantages of this route are obvious. For example, it can stop bleeding quickly and effectively; the patient’s postoperative movement and position are not restricted, which significantly improves comfort; it can reduce hospitalization time and costs, and even make outpatient coronary angiography possible. However, everything has its two sides, as our understanding of radial artery intervention continues to deepen, its weaknesses are also being exposed. The first is that because the radial artery is relatively small and very easy to spasm, so the puncture technique is more demanding, improper operation can also cause some hematoma, bleeding, pseudoaneurysm and other complications similar to the femoral artery route. Secondly, there is a certain incidence of radial artery occlusion after surgery, which usually recanalizes spontaneously in about 1 month, and a few patients may have permanent occlusion, which may bring psychological shadow to the patients. More importantly, because some patients may have anatomical variations or severe distortion of the artery, resulting in failure of the radial artery route, and some complex lesions are not suitable for the radial artery route, overemphasis on the success rate of the radial artery route may result in serious vascular complications, unnecessary prolongation of the operation time, the use of too high a dose of contrast medium, and prolonged exposure to X-rays. The proportion of radial artery pathway procedures in the author’s hospital is currently about 70%. Because of strict preoperative screening, and because all radial artery interventions are operated by physicians with extensive experience in puncture, the success rate of transradial artery procedures is up to 95% or more, and the complications are less than 1%. Conclusion: In today’s highly invasive coronary artery disease diagnosis and treatment, no matter which way to perform coronary artery disease intervention has its rationality and limitations, it seems meaningless to talk about the advantages and disadvantages. Clinicians and patients should not overly emphasize the advantages and disadvantages of a certain method, and the most optimal method is one that differs from person to person and from disease to disease. In particular, patients must be aware that it is entirely possible to have a radial artery puncture and then switch to a femoral artery puncture, and that this is the right choice for the interventionalist for safety reasons or for other reasons.