Trends in the utilization of endovascular therapy for elective and ruptured abdominal aortic aneurysm procedures in Canada.

OBJECTIVE

While randomized trials have shown improved operative mortality with endovascular aneurysm repair (EVAR) but similar long-term mortality rates, enthusiasm for EVAR persists, and rates of EVAR use continue to increase. Currently, knowledge of utilization rates of EVAR in Canada is limited.

METHODS

Patients who underwent nonruptured abdominal aortic aneurysm (AAA) and ruptured AAA (RAAA) repair, by either open surgical repair (OSR) or EVAR, in Canada were identified from hospital discharge abstract data. Trends in rates for OSR and EVAR were calculated by province and by year, and standardized per 100,000 persons over 65 years of age (per capita).

RESULTS

Between April 2004 and March 2009, 15,960 AAA procedures were performed in Canada, either by OSR (n=12,204) or EVAR (n=3756). The proportion of all elective AAA procedures by EVAR increased from 11.5% in 2005 to 35.5% in 2009, the highest current proportion of EVAR utilization in British Columbia (45.0%) and the lowest in Manitoba (15.8%). After standardization, the national rate of total procedures was steady, but the rate of RAAAs declined over the entire study period. Alberta consistently had the highest per capita rates of EVAR use (38.9), whereas Prince Edward Island had the lowest (8.4). Provincial variations in EVAR use did not correlate with differences in comorbidities. Compared with Canadian averages, Atlantic Provinces performed the most AAA procedures per capita (137.5 vs 93.4), had the highest rate of RAAAs per capita (29.7 vs 22.2), and had the lowest proportional rates of EVAR use.

CONCLUSIONS

Use of EVAR in Canada for AAAs has increased in the past 5 years, without affecting overall AAA procedure volumes. Large discrepancies in EVAR use exist across Canada. The Atlantic Provinces had the highest rates of RAAAs despite having the highest rates for total AAA procedures, suggesting a population with higher susceptibility for AAAs. This region may also have the largest potential for future increased use of EVAR.