Using a “run-of-the-mill” vascular surgeon has its own issues. When I used a vascular surgeon, they were focussed on isolating the vessels, essentially skeletanising the vessels. The consequent sympathetic issues with warm legs was extremely common. I hence moved on to using a laproscopic surgeon who was happy to work via smaller incisions and brought some laproscopic ligation tools to the surgery. This was extremely useful in clipping the ascending lumbar without a massive overexposure of vessels.
I hence like the term “Access Surgeon” better. A “true vascular surgeon” is required if and when disaster strikes and one needs things like graft/endovascular temporary blockage/ligation etc….
You need a “team” where you work with the access surgeon to define the scope of exposure, how retarctors will be placed, How you use Hohmanns (if you use them), etc. Also define clearly when they can scrub off…
The difference in UK Vs US Vs Aus has also to do with economics.
Needless to say, if someone undertakes ALIF in a Hospital without Vascular Surgical Facility – it is misplaced bravado at best and stupidity at worst.