Who doesn't need vascular medicine?—A team approach to vascular care and the role for vascular medicine

Abstract

The possibilities for diagnosis, treatment and followup of peripheral vascular disease has come a long way since the old days when treatment was often dubious and frequently involved amputation by a barber surgeon. Where are we now? Fortunately, although dubious remedies are still available, we can now rely on medicine and surgery and the many subspecialties that have sprouted from these parent disciplines. The developments in both technology and biology demands the organisation of patient care by vascular teams and the recognition of vascular medicine as part of internal medicine. New hopes and promises of treatment for peripheral vascular disease emerge with surprising frequency. The balloon angioplasty catheter is the product of a dazzling evolution towards a high-tech versatile tool. The techniques and results of vascular surgery are continuously being improved, and intensive care facilities make more complicated operations feasible. Technological developments have led to a large increase in the volume of both angioplasties and operations, although amputation rates do not seem to have improved. 1 Tailor-made medical treatment has become more rational and may become more successful with the introduction of new drugs. Other classes of drugs will emerge based on insights in molecular and cell biology in general and on the mechanisms of atherosclerosis and intimal hyperplasia in particular. The crucial role of risk factors for the development or premature atherosclerotic disease has become better recognised. For some of these, e.g. hypercholesterolaemia, drug treatment has become more effective. With all of these developments the care of the vascular patient can no longer be regarded as a field for one specialist in the traditional sense. For example, it has become clear that balloon angioplasty can be applied effectively and safely in some vessel segments but that in other segments vascular surgery is required. The roles of the vascular surgeon and the radiologist have therefore become complementary and both specialists can co-operate fruitfully to restore the circulation. Territorial wars between surgeons and radiologists do not serve the patients'