Examination of the Trend in Canada Toward Geographic Centralization of Aneurysm Surgery during the Endovascular Era

Unlike in the United States, endovascular aneurysm repair (EVAR) has not been widely disseminated in Canada but has remained limited to large-volume vascular surgery units. Since the development of the endovascular program at our hospital, we have experienced a growth in our aneurysm practice and the area of referral. The purpose of this study was to compare the geographic referral area of our aneurysm practice between 1997 (prior to the introduction of EVAR) and 2003 (EVAR and open surgery). Our prospective database was reviewed to identify patients who underwent elective open aneurysm repair in 1997 and 2003 and those who underwent EVAR in 2003. Each patient's county of residence was identified, allowing for grouping of patients into one of four geographic regions (I-IV) increasingly more distant from our hospital. Proportions were compared with the X 2 test. In 1997, 105 patients underwent open abdominal aortic aneurysm repair, with the majority of patients originating from the two regions in closest proximity to our hospital (I, 34%; II, 46%; III, 18%; IV, 2%). This contrasts with the 2003 EVAR group ( n = 63), which had a higher proportion of patients referred from greater distances (I, 13%; II, 27%; III, 27%; IV, 33%) ( p < 0.001). The 2003 open group ( n = 165) did not differ statistically with respect to region of origin (I, 18%; II, 41%; III, 21%; IV, 19%) compared to their 2003 EVAR counterparts ( p = 0.075) but did have a higher proportion of patients from the more distant regions compared to the 1997 open group ( p < 0.001). During the last 5 years, we have experienced a doubling of our elective aneurysm case volumes as well as a trend for patients to be referred from greater distances for both EVAR and open repair. This suggests a trend in Canada toward increased centralization of aneurysm care in centers providing both endovascular and open surgical alternatives.