The delivery of vital substrate to metabolically active tissues and vital organs is achieved and maintained by the cardiovascular system including the heart, macrovasculature, and microvasculature. This life-sustaining process requires a normally functioning vascular endothelium—a multifunctional organ system composed of physiologically responsive cells responsible for vasomotion (vascular tone), thromboresistance, and inflammoresistance. Simply by virtue of its anatomic location, the vascular endothelium is functionally complex. It defines the intra- and extravascular components, serves as a selectively permeable barrier, and provides a continuous lining to the cardiovascular system. The location of the vascular endothelium is vital to its biologic interactions with cells found within the circulation and to the vessel wall itself. The surface activity is augmented in the microcirculation, also known as the resistance bed, where the ratio of endothelial surface to circulating blood is maximal. In most vertebrates, vascular endothelial cells form a single layer of squamous lining cells (0.1–0.5 μm in thickness) joined by intercellular junctions. The cells themselves are polygonal (varying between 10 and 50 μm) and are positioned in the long axis of the vessel, orienting the cellular longitudinal dimension in the direction of blood flow. The endothelial cell has three surfaces: luminal (nonthrombogenic), subluminal (adhesive), and cohesive. The luminal surface is devoid of electron-dense connective tissue. It does, however, possess an exterior coat (or glycocalyx), consisting primarily of starches and proteins secreted by the endothelial cells. Plasma proteins, including lipoprotein lipase, α2-macroglobulin, heparin cofactor II, antithrombin, and albumin, as well as small amounts of fibrinogen and fibrin are adsorbed to the luminal surface. The surface membrane itself adds significantly to thromboresistance by carrying a negative charge that repels similarly charged circulating blood cells. The subluminal (or abluminal) surface adheres to subendothelial connective tissues. Small processes penetrate through a series of internal layers to form myoendothelial junctions with subjacent smooth muscle cells. The cohesive component of the vascular endothelium connects individual endothelial cells to one another by cell junctions of two basic types: occluding (tight) junctions and communicating (gap) junctions. Occluding junctions represent a physical link between adjacent cells, sealing the intercellular space.