Treatment of patients suffering peripheral arterial disease (PAD) has changed significantly over the last decades. Endovascular therapy now accounts for 25-40% of vascular interventions in Europe and, in addition, medical therapy and life style changes have proven beneficial to the PAD patient. Traditionally, open vascular surgery has been provided by the vascular surgeon, endovascular treatment by the radiologist and medical treatment by the internist or angiologist. However, patients and politicians are demanding increased service and if all treatment options for the vascular patient can be offered by the same physician in the same department, not only will demands be fulfilled, but the quality of treatment may improve as well. In most European countries the vascular surgeon decides on the indication for either open surgery or endovascular treatment. Preventive medications to avoid complications to atherosclerosis are simple to prescribe and adjust in the majority of patients and are often provided within the vascular department. The future vascular specialist will be a physician with a basic vascular training, including vascular medicine, open as well as endovascular surgery. This article describes this development, which is happening at different paces throughout most of Europe.