INTRODUCTION: Measuring Quality of Life (QoL) has become a vital part of assessing lower limb ischemia and peripheral vascular disease in international studies. The 25-item VascuQoL was developed in UK English and investigates 5 domains: symptoms, pain, activities, social life and emotional state. Prior to use in an international trial the measure underwent linguistic validation in 8 languages. METHODS: A QoL specialist coordinated the translation process in each target country using the following methodology: 1) two forward translations by professional, native speaking translators of the target language fluent in English; 2) comparison and reconciliation of the translations by a QoL specialist and translators; 3) backward translation by a native English speaker; 4) comparison of the source and backward versions; 5) review of the translation by a clinician in each country; 6) comprehension test in a sample target population; 7) international harmonization. RESULTS: Linguistic and conceptual issues emerged when translating idiomatic phrases and response scales. Linguistic equivalents had to be found for expressions such as "being (or becoming) housebound" and "social activities". The notions of "discomfort"/"distress" did not have direct equivalents in some languages where a single notion had to be used. In most languages the frequency scale expressed in amounts of time had to be simplified to establish equidistant responses. CONCLUSIONS: A rigorous translation methodology was performed to ensure conceptual equivalence and acceptability of translations. International feedback obtained through the translation process revealed issues regarding the original instrument, indicating that future amendments to the original may be necessary. Future psychometric testing will be conducted to ensure reliability and validity of each translation, appropriateness of the questionnaire in each country and comparability of data across countries.