Barriers to Accessing Vascular Surgery in Northern, Rural, and Remote Canadian Communities

Access to vascular surgery care for diabetes-related foot complications (DRFC) and peripheral arterial disease (PAD) remains limited in rural and remote Canadian communities. This narrative review, conducted through a comprehensive search of PubMed using keywords such as "Health Services Accessibility," "Peripheral Arterial Disease," and "Canada," from inception to March 30, 2025, identified 20 eligible studies from 242 screened. Eligible studies examined barriers to accessing to vascular care for DRFC or PAD in rural/remote regions of Canada. Data were extracted and synthesized using the Socio-Ecological Model of Health and structured into individual, institutional, and systemic level barriers. At the individual level, barriers identified include geography, income, cultural norms and health literacy. Institutional barriers include timely referral, access to specialized care, lack of foot care services and transport. Systemic barriers included inadequate funding of rural health services and the health care system's limitations in addressing the cultural context of remote communities. Indigenous populations, in particular, experienced higher rates of lower limb amputations, presented with more advanced PAD, and up to 15% higher post-amputation mortality. Proposed solutions emphasized expanding preventative care, improving access to specialists, creating culturally sensitive vascular health teams and consulting with at-risk communities on developing locally led solutions. Overall, individuals living in rural and remote Canadian communities, particularly Indigenous populations, face significant barriers accessing timely and appropriate vascular surgery care for PAD and diabetic foot complications. Addressing these disparities required a multi-faceted culturally informed approach across individual, institutional and systemic levels.