Summary Patients undergoing major vascular surgery are at high risk of peri-operative morbidity and mortality owing to a combination of advanced age, significant co-morbidity and the nature of the surgery. A consultant-led pre-operative assessment clinic provides an opportunity to stratify these patients on the basis of risk in advance of surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence. This results in fewer last-minute cancellations for medical reasons and increased patient satisfaction, and may improve patient outcome. Such a clinic also provides an educational arena for nursing and trainee medical staff, and importantly allows those patients in whom the risks are felt to outweigh the potential benefits of surgery to be managed in a more fully informed manner.