1. Purpose

This position statement defines the role of vascular surgeons and the standards required for safe, equitable, and effective vascular care in Australia and Aotearoa New Zealand. It outlines training and credentialling standards, clarifies scope of practice and professional responsibilities, and defines system-level principles for optimal delivery of vascular services. The intent is to safeguard patients, provide guidance for health services and regulators, and establish benchmarks for comprehensive vascular care.

2. Background and Context

Vascular disease is a major cause of death, disability, and health system burden across Australia and New Zealand. Vascular diseases are conditions that affect arteries, veins and lymphatic vessels in the whole body. They include:

• Arterial diseases such as peripheral artery disease (PAD) including the complications of diabetes in the feet, aortic aneurysm and dissection, carotid artery disease causing stroke, and acute arterial occlusions.
• Venous diseases including varicose veins, deep vein thrombosis, arteriovenous malformations, pulmonary embolism and chronic venous insufficiency.
• Lymphatic disorders such as primary and secondary lymphoedema.
• Trauma and arterial complications from chronic diseases like diabetes and renal failure.

Vascular diseases are often chronic, progressive and closely linked to cardiovascular risk factors including smoking, diabetes, high blood pressure, high cholesterol and chronic kidney disease. If not identified and managed appropriately, vascular diseases can result in chronic pain and functional limitations, stoke, limb loss, and premature death. Management ranges from ‘conservative’ (non-interventional options), including lifestyle modifications, optimisation of therapeutic and preventative medical therapy, and physical therapies to complex procedural interventions requiring high-level skills. Any procedural intervention should include comprehensive postoperative care, diligent long-term care, and surveillance.
In 2022-23, peripheral vascular disease accounted for approximately 55,000 of hospitalisations per year in Australia, and the age-standardized hospitalization rate is increasing in Aotearoa NZ. Vascular disease is a growing health burden; our region has one of the highest burdens of peripheral arterial disease globally, and although improvements in care have
decreased disability adjusted life years (DALYS) overall, the burden of disease is increasing in older people, women, Aboriginal and Torres Strait Islander people, Māori and Pacific Islander people and people living in rural and remote communities. The ANZSVS is spearheading interventions to address these inequalities, including through the Vascular Foundation and SAL-VAGE.

3. Scope of Practice

The treatment of vascular diseases has undergone substantial evolution in the past few decades. Where once open surgery was the mainstay of treatment, vascular surgeons now employ a wide range of diagnostic, medical, and procedural modalities in the management of vascular diseases. Because of this, vascular surgeons have become highly adept at comprehensive care of vascular disease, from early diagnosis, risk factor modification, perioperative care and definitive treatment. The training and scope of practice for vascular surgeons reflects this ‘whole-person’ model of care delivery. Whilst multiple professional groups also contribute to aspects of vascular care, vascular surgeons are the only specialists trained and credentialled to provide the full spectrum of management, including diagnostic, medical, endovascular, and open interventions. Vascular surgeons also provide critically needed support to other medical and surgical specialties; in one tertiary hospital, acute supportive care was provided to other surgical specialties at least once every 4 days.
The practice of vascular surgery extends across all domains of vascular disease. Vascular surgeons provide:

• Comprehensive assessment and longitudinal management of arterial, venous, and lymphatic disease
• Vascular imaging and physiological testing including performing and interpreting vascular ultrasound, angiography and other vascular imaging modalities
• Delivery of open, endovascular, and hybrid surgical interventions
• Risk factor management including prescription of medications, exercise therapies, and long-term health interventions
• Acute and chronic wound management, in the context of overall disease care
• Management of complex conditions such as diabetes-related foot disease, dialysis access, vascular anomalies, and trauma
• Supportive care including end of life decisions, for patients with severe, life limiting vascular conditions

This scope is distinctive because vascular surgeons integrate all treatment modalities and assume primary responsibility for continuity of care, decision-making, and outcomes.

4. Credentialling and Professional Standards

Specialist recognition: To be recognised as specialist vascular surgeons in Australia and Aotearoa New Zealand, surgeons must undergo a rigorous training process. The Royal Australasian College of Surgeons Vascular Surgical Education and Training program (RACS SET) is the only training pathway accredited by the Australian Medical Council (AMC) and New Zealand Medical Council. Surgeons awarded a Fellowship of the Royal Australasian College of Surgeons (FRACS Vascular) qualification have completed general hospital-based medical training, are selected into, and complete the highly competitive comprehensive five-year specialist vascular surgery training program and successfully complete in-training assessments including a high-stakes exit examination. Internationally trained specialists in vascular surgery must demonstrate comparable training outcomes to the FRACS (Vascular) qualification and undergo a supervised evaluation period or further training to ensure comparability.

Training pathways: The vascular training program in Australia and Aotearoa New Zealand was the first in the world to mandate dual competency in both open and endovascular surgery. Trainees consistently achieve operative numbers that exceed those of many comparable international programs, providing a solid foundation for independent practice. The curriculum is tailored to the geographical and demographic context of our region, with particular emphasis on the health of Aboriginal and Torres Strait Islander peoples, Māori communities, and patients in rural and regional areas. Surgeons awarded FRACS (Vascular) are internationally recognised for the quality of their training and the breadth of their skills.

Credentialling: Specialist recognition of vascular surgeons qualifies them to operate vascular ultrasound laboratories, providing diagnostic services. They are also credentialled for the full range of vascular treatments including open and endovascular therapies. Local credentialing decisions should be evidence-based, reflecting training pathways, case volumes, outcomes, and participation in audit. This may include require proceduralists to demonstrate additional accreditation for high-risk interventions such as complex aortic surgery, carotid endovascular procedures and radiation safety. The ANZSVS hold the position that endovascular procedures have potential for catastrophic complications and require oversight by consultants trained and credentialed to be responsible for the full peri-procedural care, including management of complications and, when required, open conversion. Where interventional radiologists are performing endovascular procedures, local health services should establish collaborative arrangements that support vascular surgeons to co-perform procedures and manage patients, sharing admitting rights, postoperative care responsibilities and escalation.

Professional standards: Ongoing credentialling requires surgeons to comply with yearly continuing professional development (CPD) activities, peer reviewed clinical practice and mortality audits, and retain registration with the Medical Board of Australia (AHPRA) or Te Kauniherea Rata o Aotearoa (Medical Council of New Zealand). Practice is underpinned by adherence to the ethical frameworks of RACS and ANZSVS. The ANZSVS has an internationally recognised whole-practice audit, the Australian Vascular Audit, contributed to by all member surgeons.

5. Core Competencies in the Practice of Vascular Surgery

Vascular surgeons integrate clinical knowledge, technical expertise, and professional accountability across the continuum of vascular disease management. Their practice is defined by comprehensive clinical assessment, mastery of multiple treatment modalities, and the capacity to determine when surgical or interventional treatment is appropriate, and when it is not. The ten professional competencies outlined by RACS provide the foundation for professional vascular practice. On completion of vascular training, all vascular surgeons demonstrate competency in:

a. Comprehensive patient care for the full continuum of vascular disease (including in emergency, outpatient and inpatient settings)

Vascular surgeons deliver longitudinal care that spans prevention, diagnosis, intervention, complication management, and lifelong surveillance. They adopt a whole-person approach, balancing disease burden, comorbidities, and individual preferences. Their practice is grounded in consistent, evidence-based methods for investigation, diagnosis, staging, and screening, integrating patient-specific factors with anatomical and pathological findings to guide treatment. Vascular surgeons have expertise in prescribing and monitoring medical and adjunctive therapies relevant to vascular disease, including management of common pharmacological side effects and contraindications for use. In decision-making, they incorporate multidisciplinary perspectives, support shared decision-making with patients, and consider health resource utilisation and population-level outcomes when determining the optimal course of care. This approach ensures that patients receive tailored management that may include intervention, conservative therapy, or palliation according to individual needs and preferences.

b. Expertise in the full breadth of vascular procedures

Vascular surgeons are the only specialists formally trained to perform all open, endovascular, and hybrid vascular procedures. This breadth enables them to select the most appropriate option for each patient, or to recommend no intervention when risks outweigh benefits. They adhere to clinical guidelines and current evidence when making management decisions, and work effectively in multidisciplinary teams to optimise outcomes. Vascular surgeons exercise reasoned, evidence-based judgement when selecting procedures, devices, and when considering open surgery. They diagnose, investigate, and manage complications of endovascular surgery, and apply techniques to mitigate risks, including radiation exposure. They also provide vascular trauma services when required, assist colleagues with iatrogenic injuries or complex surgical exposures, and contribute in multi-proceduralist settings.

c. Comprehensive perioperative and post operative care

Vascular surgeons demonstrate knowledge and application of the principles of perioperative care. They risk stratify patients and initiate appropriate preoperative investigations, incorporating perioperative risk into management plans in a patient-centred manner. They function effectively in multidisciplinary, collaborative care environments, valuing input from anaesthetics, cardiology, endocrinology, geriatrics, and other specialties. Vascular surgeons are skilled in identifying postoperative complications and apply strategies for prevention, early recognition, and treatment.

d. Applied knowledge of fundamental vascular anatomy, pathophysiology and function

Vascular surgeons have a firm grounding in the core principles of vascular disease, including anatomy, pathophysiology, and vascular biology. Their expertise is based on a detailed understanding of the full range of treatment modalities used in vascular surgery, encompassing radiation physics, vascular ultrasound, and the haemodynamic and material properties of endovascular and prosthetic devices.

e. Multidisciplinary Leadership

Vascular disease requires the coordinated input of multiple specialties and allied health providers. Vascular surgeons lead these teams, ensuring integration of diverse expertise and continuity of care. They are responsible for managing treatment failures, adapting strategies, and providing definitive guidance on the most appropriate pathway, whether surgical, endovascular, medical, or palliative.

f. Evidence-based practice and accountability

Vascular surgeons use clinical guidelines and current evidence to guide treatment decisions, while also considering health resource utilisation and population health outcomes. Vascular surgeons adhere to the codes of professional practice, outlined by RACS.

6. Optimal Care Environments

The ANZSVS advocates that safe, equitable vascular care is optimally delivered in healthcare systems that are:

• accredited hospitals equipped with hybrid operating theatres, intensive care, vascular nursing expertise, and access to specialist perioperative services.
• high-procedural volume units with experienced multidisciplinary care teams who can streamline referrals, minimise treatment delays, and support shared-decision making.
• integrated services connecting acute interventions with longer-term multidisciplinary chronic disease management, including wound care, podiatry, aged-care and rehabilitation, and primary health networks.
• established regional hub-and-spoke networks enabling rural and remote patients to access complex care via outreach clinics or telehealth, and defined treatment escalation and retrieval pathways.
• safety and quality monitoring through credentialing processes, registry participation and clinical audit, ensuring ongoing quality improvement and transparency in outcomes.
• consumer partnerships that inform the development of culturally informed models of care that are targeted towards the needs of local communities and priority populations.

7. Multidisciplinary Collaboration

Vascular care is enhanced through collaboration with many other clinical disciplines including vascular nursing, podiatry, interventional radiology, cardiology, endocrinology, and allied health. Vascular surgeons play a central role in coordinating these inputs, ensuring integration and continuity of care.

8. Addressing Health Inequities

Health inequities in vascular disease are pronounced. Aboriginal and Torres Strait Islander people, Māori, Pacific people, and rural and remote populations experience higher rates of vascular disease and worse outcomes, including amputation. Vascular surgeons trained in Australia and Aotearoa New Zealand are uniquely positioned to address these inequities through:

• Leadership in designing regional networks, outreach services, and workforce planning that prioritises underserved populations.
• Culturally safe practice that respects and responds to diverse patient needs.
• Advocacy with policymakers to improve access to revascularisation, dialysis access, and limb salvage.
• Contribution to registries and clinical trials that highlight inequities and guide improvement strategies.

9. Workforce Distribution and Planning

Australia and Aotearoa New Zealand face unique challenges in vascular workforce planning due to substantial geographic distances and the maldistribution of clinicians across rural and remote regions. Rising rates of diabetes, an ageing population, and widening socioeconomic inequities are expected to substantially increase the prevalence of vascular disease. Current workforce estimates indicate that the existing surgeon-to-population ratio will be insufficient to meet projected demand.

At the same time, emerging treatments and advances in prevention may moderate growth in surgical and endovascular interventions. This underscores the importance of a specialist workforce that is comprehensively trained in the full spectrum of vascular management, including medical therapy, preventative strategies, and non-interventional care. Currently, vascular surgeons are the only specialists in Australia and Aotearoa New Zealand trained to deliver this integrated approach. 

The ANZSVS is working in partnership with the Australian Department of Health and Aged Care and Te Whatu Ora in Aotearoa New Zealand to inform future workforce planning and distribution. In anticipation of increasing demand, the Society has expanded training positions to strengthen the pipeline of highly skilled vascular specialists who reflect the diversity and geographic needs of the communities they serve.

10. Accreditation, Audit and Quality Assurance

Vascular surgery is distinguished by its robust systems of accreditation and ongoing quality assurance. The specialty is committed to transparency and accountability. Vascular surgeons contribute to the national Australian Vascular Audit (AVA), peer review, and registry participation, ensuring outcomes are monitored and standards continually raised. The AVA provides transparent peer-reviewed reporting of individual surgeon performance, is internationally benchmarked through participation with Vascunet, and has high rates of participation and compliance. As a member of the World Federation of Vascular Societies, the ANZSVS is recognised as a major contributor to global vascular practice. As a professional body, the ANZSVS also participates in evaluation of new technologies or procedures, advising on how to safely adopt new innovations into current health systems. The ANZSVS is actively involved in workforce development, training standards, and training hospital accreditation through the RACS Board of Vascular Surgery, accredited by the Australasian Medical Council.

11. Recommendations

• Hospital Standards: Vascular surgery should be performed in hospitals with the expertise, caseload, and infrastructure necessary to ensure optimal outcomes and patient safety. This includes access to hybrid operating theatres, comprehensive perioperative services, and vascular ultrasound. 
• Equitable Access: Health services should ensure that specialist vascular care reaches communities facing barriers to access, prioritising populations experiencing health inequities. This includes sustainable funding for hub-and-spoke models, telehealth, targeted outreach, and retrieval pathways.
• Training and Accreditation: All training pathways for clinicians providing vascular care should be accredited by the Australian Medical Council and underpinned by a comprehensive curriculum with robust, competency-based assessment of knowledge, judgement, and operative skill.
• Practice Scope and Credentialling: Vascular surgery remains the only specialty credentialled by the Australian Medical Council and recognised by AHPRA to deliver comprehensive vascular care from prevention and diagnosis to intervention and surveillance. All clinicians performing vascular interventions should complete accredited, comprehensive training encompassing the full range of treatment options, complication management, and contraindications.
• Multidisciplinary Collaboration: Multidisciplinary models of care provide optimal outcomes for patients with vascular disease; however vascular surgeons must be included as core participants in decision-making about treatment options to ensure that patients are informed of, and able to access, all available treatments. Vascular surgeons should actively participate in multidisciplinary team meetings, seeking feedback and peer review on patient management and treatment plans.
• Communication and reporting: Vascular surgeons should provide timely and clear communication to referring doctors and other treating clinicians about management plans, relevant options, and shared decisions. Diagnostic and treatment reports should be accurate, timely and transparent.
• Professional Standards and Continuous Improvement: Clinicians providing vascular care should engage in specialty-relevant continuous professional development, audit, and quality improvement to maintain high standards of care.
• Workforce Planning and Diversity: The vascular surgical workforce must maintain a sufficient pipeline of highly-credentialled vascular specialists to meet the projected clinical needs of Australia and Aotearoa New Zealand. The ANZSVS and RACS Board of Vascular Surgery should continue to expand access pathways and recruitment initiatives to enhance diversity and geographic distribution. Sufficient training and supervision should be provided

12. Conclusion

Vascular surgeons are uniquely positioned to deliver safe, effective, and equitable care for patients with vascular disease. Their practice scope encompasses the full spectrum of diagnostic, medical, endovascular, and open surgical management. Members demonstrate adherence to robust accreditation standards, ongoing audit, and a commitment to addressing health inequities. The standards set out in this statement represent the minimal standards for vascular disease management in Australia and New Zealand.