Centralisation of principal vascular services to tertiary centres has great merit in enabling adequate specialist numbers to provide an acute service with appropriate support facilities. Demand on this vascular service is expected to increase almost 100% with the aging population over the next 20 years. The demography of the population of New Zealand and Australia is such that providing vascular services only in tertiary centres has great potential to disenfranchise many patients living in rural areas. Unless the overall provision of service is excellent, providing an excellent service for only part of the population is untenable.A purely centralised, regional service will have difficulty providing satisfactory care for elderly infirm patients, with limited mobility, who live in rural areas. General Surgeons with no vascular training, working in provincial or rural hospitals cannot be expected to spend the significant time required to triage patients with possible peripheral vascular disease simply to refer them on to vascular surgeons in distant tertiary centres. Many aspects of vascular surgery, relating both to patient assessments and operative procedures do not require tertiary
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