DIRECTORS' NOTE

The number of patients with End Stage Renal Disease (ESRD) is increasing worldwide every year, so do patients on Hemodialysis. Vascular access maintenance is of paramount importance for these patients. Within the last ten years there is increasing interest, technological advancements and evidence to support the endovascular first approach for the treatment of dysfunctional and thrombosed vascular access, together with tunneled catheter insertion and last option salvage procedures, while lately the ability of endovascular vascular access creation is gaining increasing interest further extending the service endovascular specialists can provide to hemodialysis patients.