The majority of abdominal aortic aneurysms (AAAs) occur in the sixth and seventh
decades of life and occur more frequently in males than in females by a 3:1 ratio.
The majority of AAAs are asymptomatic. An AAA can be associated with other cardiovascular
The overall detection rate of AAAs on examination is 31%. Detection during a physical
examination depends on aneurysm size and is affected by obesity. Clinical examination
identifies approximately 90% of aneurysms greater than 6 cm. Auscultation of an
abdominal bruit may indicate the presence of an aneurysm.
Risk of rupture
Rupture is the most serious complication of an AAA and can be life threatening.
The risk of rupture increases as the aneurysm increases in size.
- Less than 4 cm rarely ruptures.
- Smaller than 5 cm has a 1% to 3% per year rate of rupture.
- 5 cm to 6 cm has a 5% to 10% per year rate of rupture.
- Greater than 7 cm has approximately a 20%
per year rate of rupture.
Monitoring of an aneurysm is advised because the growth rate can vary and rapid
expansion can occur.
Certification/Recertification — Abdominal Aortic Aneurysm
Minimum — 3 months for post-surgical repair of an aneurysm
NOTE: If more than one waiting period applies (because of multiple
cardiac conditions or other comorbid diseases), examine the driver for certification
after the completion of the longest waiting period.
Maximum certification period — 1 year
Recommend to certify if:
The AAA is:
- Less than 4 cm and the driver is asymptomatic.
- Greater than 4 cm but less than 5 cm and the driver is asymptomatic
and has clearance from a cardiovascular specialist who understands the functions
and demands of commercial driving.
- Surgically repaired and the driver meets post-surgical repair of aneurysm guidelines.
Recommend not to certify if:
The driver has:
- Symptoms, regardless of AAA size.
- Recommendation for surgical repair, regardless of AAA size, from
a cardiovascular specialist who understands the functions and demands of commercial
- Is greater than 4 cm but less than 5 cm and driver does not have
medical clearance for commercial driving from a cardiovascular specialist.
- Is greater than or equal to 5 cm.
- Has increased more than 0.5 cm during a 6 month period, regardless
Ultrasound has almost 100% sensitivity and specificity for detecting an AAA and
is recommended to monitor change in size.
The driver should have an annual medical examination.
Aneurysm Recommendation Table (PDF) — Abdominal Aortic Aneurysm