This chapter examines the intricate vascular anatomy of the wrist and hand, focusing on its clinical relevance to distal radial access (DRA) for percutaneous procedures. It describes the complex network of arteries and anastomotic arches with highly variable patterns developed during the embryological phase and discusses anatomical variations and their impact on blood flow dynamics. Due to their major role in the digital blood supply, the superficial and deep palmar arches represent the most important connections. Using different visualization techniques and anatomical classifications, highly variable completeness rates are reported for both palmar arches. The prevalence of incomplete superficial and deep palmar arches is detailed, highlighting significant geographic variability and exploring their clinical implications. Various methods of assessing hand circulation are described, including angiography, which provides a real-time assessment of arterial vascularization. The discussion concludes by identifying gaps in knowledge and potential areas for future research, such as the distinct role of specific anatomical features in preserving arterial flow. The potential for ultrasound-guided site selection in DRA procedures and the implications of angiographic findings for optimizing patient outcomes are also reviewed.