Edinburgh Regional Vascular Surgery Unit: development of emergency practice 1983-1992.

Emergency referrals made to the Edinburgh Regional Vascular Surgery Unit in the first two months of 1983, 1987 and 1992 have been analysed with respect to demographic information, source, diagnosis and management. The total number of referrals made in the study period of each year was 72, 129 and 200 respectively. The male to female ratio was 1:1 for each year. Patients referred in 1992 were significantly older than those referred in 1983 (P < 0.05 by two-sample t test). The marked increase in the number of referrals from other hospitals and centres has been largely responsible for the dramatic threefold increase in the emergency workload. Overall, 80% of patients were referred with arterial disease and in over 50% this was infra-inguinal. In 1983, 50% of acute limb ischaemia was embolic compared with less than 25% in 1992. There has been a marked increase in the number of asymptomatic and symptomatic but non-ruptured abdominal aortic aneurysms referred compared with only a small increase in the number of ruptured aneurysms. Vascular access for renal dialysis remains an important part of the overall workload. Overall, 50% of patients referred were admitted and 37.5%, 26.5% and 15.5% of patients underwent emergency surgery in 1983, 1987 and 1992 respectively.