Provision of a vascular service in a district general hospital.

The effect of the appointment of a vascular interest surgeon (VIS) on the provision of a local vascular service has been analysed with regard to change in workload, over the 2.5 years before and after appointment. During the period analysed (1989-1994), there was an increase in elective vascular surgery: aorto/iliac reconstructions (11 v 58) and femoro-distal reconstructions (5 v 34). Carotid/subclavian, femorocrural and endoscopic cervical sympathectomy were introduced. There was a reduction in tertiary referrals (14 v 34). An associated increase in arteriography (196 v 280), angioplasty (38 v 74) and chemical sympathectomies (12 v 27) was observed. Major amputations, however, decreased (64 v 49). There was a decrease in emergency vascular operations performed; ruptured aneurysms (23 v 15), embolectomy (17 v 10). 50 per cent of these operations were performed by the VIS. The appointment of a vascular surgeon increases surgical, radiological and anaesthetic workload but there are still problems in the provision of a local vascular service.