Variation in management of intermittent claudication by vascular surgeons in Scotland

Objectives: The principal aim was to determine the extent to which intended and actual management varied among vascular surgeons. Design: Prospective survey. Methods: A nationwide survey of initial management of, and determination of subsequent surgical management in, 1180 patients with a diagnosis of intermittent claudication made by 28 vascular surgeons was carried out in Scotland. Results: The proportion of patients considered for conservative management varied between consultants from 10-83% (mean 42%, S.D. 16%). The proportion considered for angiography varied from 13-80% (mean 46%, S.D. 14%). For surgery, the range was 4-68% (mean 37%, s.D. 14%) and for angioplasty the range was 13-90% (mean 49%, S.D. 19%). All differences in management intention between consultants were significant (p<0.001). The differences between consultants in terms of treatment actually received within 6 months were less striking but still significant (p<0.05). All consultants actually managed more patients conservatively than they had originally intended, but there was poor correlation between intended and actual practice. Conclusions: In Scotland the variations between surgeons in both intended and actual management are substantial. Large scale randomised controlled trials of treatment of claudication are urgently required to make clear the best treatment strategies.