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Guidance/Advisory Criteria — Conditions

Abdominal Aortic Aneurysm

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 disease.

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.

An AAA:

  • 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

Waiting period

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.

Decision

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 driving.

The AAA:

  • 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 of size.

Monitoring/Testing

Ultrasound has almost 100% sensitivity and specificity for detecting an AAA and is recommended to monitor change in size.

Follow-up

The driver should have an annual medical examination.

Aneurysm Recommendation Table (PDF) — Abdominal Aortic Aneurysm

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