Early trans-radial operators adopted the palpatory technique probably due to operator comfort. The challenging bimanual technique needed to use both vascular ultrasound probe and the puncture needle at the same time. Radial approach has some complications like radial artery occlusion, radial artery spasm, hematoma, pseudo-aneurysm, radial artery dissection, bleeding and upper extremity dysfunction. Therefore, proper physical assessment of the forearm, wrist and hand is essential before the procedure. The aim of this study is to evaluate; Feasibility, real-time and complications of trans-radial access comparing the ultrasound guidance versus the fingertip palpatory approach in coronary diagnostic and interventional procedures.Methods: One hundred patients were admitted to the hospital and planned for diagnostic coronary angiography and or elective percutaneous coronary intervention via trans-radial access. patients were divided into two groups Group 05 patients undergone coronary intervention via palpatory fingertip guided approach for transradial access. Group two 05 patients undergone coronary intervention via ultrasound guided approach for transradial access. Procedural outcomes of the whole study population, 7% end by spasm, 3% had bleeding complications, and 9% end by Sheath insertion failure and crossover to another site .there was no statistical significant difference between two groups as regard creatinine level and LVEF .there was no statistical significant difference between two groups as regard technical data or medications used, while there was statistical significant difference between groups as regard attempts of cannulation, time to access, first pass success and difficult access ≥ 5 attempts. There was no statistical significant difference between groups as regard spasm or bleeding complications, while there was statistical significant difference between groups as regard Sheath insertion failure and crossover to another site with lower incidence among US guided group. UGRAA improved first-attempt success rates and shortened the time needed for radial artery cannulation when compared to historical data of palpation-directed radial artery access. Furthermore, this technique is easy to learn and incorporate into everyday practice in the cardiac catheterization lab.