When we consider how far the clinical field comprising dialysis access creation, maintenance, and intervention has come in recent years, it is tempting to dwell for a moment and focus on the progress made. The consensus documents, the collaborations within and across specialties, and the wide variety of trial data and device innovations coming to market are just a few of the signs of true advancement. To see the rapid rise in physician and industry attention to this long-neglected field is gratifying, and we can all appreciate the promise of improved outcomes for this challenging population.

However, it can also be said that much of this progress has been largely “on paper,” and we have now reached the threshold of seeing how it is tested and proven in real-world dialysis practices.

This dialysis access–themed issue of Endovascular Today aims to highlight the latest milestones in the field but also explore the challenges each faces when it comes to implementation—to identify the reality within the understandable enthusiasm. Will society guidance be implemented as drawn up? Will trial results stand up outside of controlled environments? Will reimbursement and affordability be the most influential metrics associated with each decision? These are just a few of the questions each promising development must address before it can be counted as successful or truly innovative.

We begin with an expert panel looking at percutaneous arteriovenous fistula creation—a potential paradigm shift to one of the field’s longest-standing pillars—but only if its real-world data match trial experiences, and just as importantly, if sustainable referral and care pathways can be developed. Drs. Alejandro Alvarez, Neghae Mawla, Robert Shahverdyan, and Allison Tan share their experiences to date.

Next, Drs. Andrew Holden, Narayan Karunanithy, Scott O. Trerotola, and Haimanot (Monnie) Wasse dissect data from large-scale drug-coated balloon trials to determine how these devices will fare outside of controlled (and funded) environments.

Turning the page to imaging in access, Kate Steiner, MBBS, shares insights into early research on ultrasound evaluation capabilities in native fistula stenoses, while Stephen E. Hohmann, MD, explores the potential utility of intravascular ultrasound in dialysis access.

Finally, we interview Timothy Pflederer, MD, on differences in hospital and nonhospital practices and the sizable role that reimbursement plays in all aspects of dialysis and renal disease care.

Outside of our feature on dialysis access, the Endovascular Today editors have invited key perspectives on interventional stroke care in 2021, with leadership from multiple societies weighing in on global trends related to the pandemic, stroke systems of care, and prehospital paradigms. Elsewhere, the outgoing and incoming Presidents of the Society for Vascular Medicine, Drs. Raghu Kolluri and Herbert Aronow, respectively, share the ongoing and future goals of the society. Closing our issue, Sahil A. Parikh, MD, reflects on his pathway to interventional cardiology and vascular medicine, antiproliferatives, pulmonary embolism responses, recent Society for Cardiovascular Angiography & Interventions guidance, and emphasizing family time.

We are grateful for the time and expertise shared by the many authors and panelists who contributed to this issue, and we hope you find it timely and informative for your practice.

Bart Dolmatch, MD
Neghae Mawla, MD
Guest Chief Medical Editors