The most common of all vascular procedures, access, had long been ignored, but recently, there has been increasing interest in this important aspect of vascular intervention. Beginning with “The Art of Access” at ISET 2009, many recent educational meetings have begun to stress the importance of arterial access. In this month's issue, both access and closure techniques will be discussed in detail, as improvements in each regard continue to result in better outcomes in endovascular therapy.

Jihad A. Mustapha, MD, FACC, FSCAI; Larry J. Diaz-Sandoval, MD, FACC; Carmen M. Heaney, RN, BSN, CCRC, CIP; and Matthew W. Sevensma, DO, begin the discussion on access and closure techniques with an article that explains the importance of extensive preprocedural planning and employing a hybrid percutaneous artery access strategy in patients with severe peripheral artery disease to prevent limb amputation.

The preclose technique is another innovative way to apply percutaneous repair in patients who are too high risk to undergo an open procedure. An article by Zvonimir Krajcer, MD, explains how a femoral access approach to totally percutaneous endovascular abdominal aortic aneurysm repair and the preclose technique allow interventionists to achieve optimal results with low complication rates.

John H. Rundback, MD, FSVM, FAHA, FSIR, and Kevin “Chaim” Herman, MD, point out the pros and cons of different access sites for hemodialysis and offer their suggestion for the best approach to managing dysfunctional fistulas.

Finally, experts from various specialties, including Gary M. Ansel, MD, FACC, FSCAI; Sumaira Macdonald, MBChB (Comm.), FRCP, FRCR, PhD; Edward Y. Woo, MD; Jafar Golzarian, MD; Nabeel R. Rana, MD; Robert M. Bersin, MD, FSCAI, FACC; and Andrew Holden, MBChB, FRANZCR, share their opinions on how they approach the many complex issues associated with access and closure in their daily practice.

In our Vessel Update, we cover the recent US Food and Drug Administration expanded indication for Abbott Vascular's (Santa Clara, CA) Acculink stent system, which features an interview with CREST investigator William A. Gray, MD. We also have a Challenging Cases article from Karthikeshwar Kasirajan, MD, who describes how he effectively treated a high-surgical-risk patient with a type II thoracoabdominal aortic aneurysm using a complex system of customized endografts. Katharine L. Krol, MD, provides an overview of the 2011 Current Procedural Terminology codes for lower extremity revascularization procedures. Our issue concludes with a discussion with Tony S. Das, MD, regarding his involvement with medical education and device development, as well as stent choice for treating superficial femoral artery disease and what's next in peripheral arterial disease therapy.

All in all, this is another jam-packed issue of Endovascular Today that we hope will provide important, timely, and valuable information for improving your practice.