Purchasing vascular services

EDITOR,—The data in Malcolm Forsyth's letter commenting on the development of specialised vascular units add little to the argument because they make no concession to two important factors related to survival after surgery for aortic aneurysm—namely, mode of presentation and selection of patients.1 A large proportion of patients who present as an emergency decreases overall survival while a small proportion improves it. A better test of a unit's ability …