Chapter 4: Vascular Disorders
Untreated aneurysms, even if asymptomatic are unlikely to be compatible with medical certification
unless it can be demonstrated that the risk of rupture is less than 2% per year. The presence of an aneurysm
e.g. in the abdomen of a middle-aged or older pilot raises concerns about the presence of co-existing
conditions, particularly coronary artery disease. Prosthetic graft replacement of diseased aortic
aneurysms with no other evidence of risk will be considered on an individual basis.
Asymptomatic Carotid Bruit
Since the presence of a carotid bruit may indicate severe stenosis, it should lead to a carotid doppler
examination. Likewise a cardiovascular assessment is required to rule out significant coronary artery
disease. Significant stenosis (>75%) even asymptomatic is associated with a >33% risk of
coronary events over 4 years and therefore renders the applicant unfit. Any stenosis that has been
associated with a stroke will also make the applicant unfit.
Individuals who have sustained an isolated, arterial thrombosis will be considered on an individual basis.
Of particular concern are thromboses related to coagulopathies or other chronic predisposing
conditions.
An isolated episode of deep venous thrombosis need not preclude medical certification provided there are
no chronic predisposing conditions, and a minimum of 3 months have elapsed since the episode.
Applicants with recurring episodes or with known predisposing factors will be considered on an
individual basis only after 12 months have elapsed since the last episode and their risk of recurrence is
lowered by satisfactory anticoagulation. In such cases only short haul pilots on anticoagulation will be
considered for a restricted category. The latter requires demonstration of therapeutic INR levels
over a recent 1 month period.
Applicants with an isolated episode of pulmonary embolism, without predisposing conditions for
recurrence can be considered for relicensure after an interval of 3 months, provided there is no disabling,
residual pulmonary hypertension, right ventricular function is normal and the risk of venous thrombosis
and pulmonary embolism is decreased by appropriate treatment to an acceptable level.
|
