Introduction: Although transradial access (TRA) is widely accepted for cardiac catheterization, technical difficulties may occur due to variations in the radial-brachial-subclavian artery anatomy. Clinical Vignette: A 70-year old man presented with typical angina, positive stress test and normal LV function. Elective coronary angiography via TRA was planned since there were no contraindications. A guidewire was inserted and advanced via right radial puncture. Due to resistance above the elbow, the wire was withdrawn and check shoots were taken. These revealed a brachial loop, which was crossed and straightened with a Teflon coated angioplasty wire (0.014BMW wire). On advancing further, resistance was encountered again. Check-shoots at this point revealed multiple tortuous tornado-like brachial loops. Attempts to cross these using a BMW wire and 4F-RCA guiding catheter were unsuccessful as the artery went into spasm, preventing further manipulation. Ipsilateral TRA was abandoned due to risk of arterial perforation and severe pain; contralateral TRA was not attempted due to patient’s refusal. The procedure was completed via femoral access. Discussion: To the best of our knowledge, this is the first report of multiple brachial loops, which highlights certain unique challenges- 1. Complex anatomic variations can occur exclusive of signs used to assess TRA amenability 2. No guidelines on procedural techniques 3. No data to guide the alternative access site as it is unknown whether brachial loops tend to occur bilaterally, unlike radial loops 4. Unlike radial and subclavian arteries, there are no data on association of demographic factors with brachial artery variations. Conclusion: Anatomic variations of upper limb arteries, although rare, can cause technical difficulties and TRA failure. If resistance is encountered, an angiogram should be performed through the sheath to assess anatomy, to prevent severe spasm and perforation from forceful catheter advancement.