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Writing the history of a medical specialty necessitates extensive historical and bibliographic research and the collection of data from various other sources such as in- formation from medical people. The author must be ex- perienced in collecting, evaluating and crosschecking the historical data in a scientific way to preserve objectivity. Undertaking this task of presenting the history of vascu- lar surgery in Europe is difficult within the allotted time constraints, which necessarily are in conflict with being comprehensive and objective.

Atherosclerosis is a complex disease involving various vascular segments and blood vessels such as the aorta, carotid, coronary and/or peripheral arteries. Taken to- gether, the thrombotic or thromboembolic complications arising from this systemic process (stroke, myocardial in- farction and gangrene) are the leading causes of morbid- ity and mortality in United States, Europe and also Asia.

Peripheral arterial disease (PAD) is associated with a high risk of vascular events [1, 2, 14, 18, 19, 31, 32]. This is true whether PAD is symptomatic or asymptomatic.This risk is so high that PAD is considered as a coronary heart disease (CHD) equivalent [5, 13]. It follows that these patients need to have their modifiable vascular risk fac- tors controlled. Dyslipidaemia, a modifiable vascular risk factor, should be treated aggressively with lipid-lowering drugs, according to international guidelines [5, 13, 16, 37]. The earlier low density lipoprotein-cholesterol (LDL-C) targets {European LDL-C target <96 mg/dl (2.5 mmol/l)

In daily clinical practice, the vascular surgeon frequently has to evaluate and manage patients who present with venous thrombosis. Identifying the cause of this disease along with its risk factors has several interesting implica- tions, which are reviewed in this chapter concerned with abnormalities in the blood clotting mechanism that gen- erates hypercoagulation states.

Noninvasive vascular laboratory findings remain impor- tant in the diagnosis of peripheral arterial disease (PAD). In many circumstances they are as accurate as invasive imaging and have the advantage of being quick and in- expensive. The two basic modalities of evaluation are the (ankle brachial pressure index, Doppler wave forms, treadmill exercise) that provide location and functional severity of disease, and the evaluation, colour duplex imaging (CDI), which provides more specific anatomical and physiological information.

Angiography is the most used invasive technique to study vascular disorders. It consists of the introduction of iodinated contrast material into the vascular system, through percutaneous direct injection or catheterization of the vessels, allowing its visualization by X-rays. It fol- lowed the discovery by Roentgen of the capability of us- ing radiation to visualize the bodily structures.

To diagnose vascular disease,physicians usually base their decision on clinical history and physical examina- tion of the patient, as well as visual inspection of medi- cal images. In some cases, confirmation of the diagnosis is particularly difficult because it requires specialization and experience, or even the application of interventional methodologies (e.g. arteriography). While advances in medical imaging technology have greatly contributed to early detection and diagnosis of vascular disease, the selection of patients to whom surgery is offered remains one of the most challenging tasks in the management of vascular disease.

The purpose of preoperative evaluation is to identify and, if necessary, implement measures to prepare higher risk patients for surgery. Preoperative evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries [4]. With the high likelihood of un- derlying coronary artery disease and the high degree of haemodynamic cardiac stress with profound alteration in heart rate, blood pressure, vascular volume, bleeding and clotting tendencies, vascular surgery represents an inter- mediate (1–5%)to high (>5%)mortality risk.

The vascular patient is at high risk of complications in the peri-operative period,due to the generalized nature of the atherosclerotic disease and other concomitant dis- eases.The aim of peri-operative care for the vascular pa- tient is to minimize the risk of complications by:

In the last two decades the most crucial event in the evo- lution of vascular surgery has been the advent of endo- vascular techniques.