Military-Specific Management of Active Duty Patients With Aneurysm or Dilation of the Ascending Aorta.

Abstract

Military servicemembers with ascending aortic dilation or aneurysm have unique occupational constraints, including physical requirements and the potential for deployment to overseas or remote environments that make management decisions challenging. There are understandable concerns that certain physical activities may trigger aortic complications. Although civilian guidelines provide evidence-based criteria for the management and risk mitigation of these patients, there are presently no military-specific recommendations. A panel of military and civilian subject matter experts across the fields of cardiology and cardiothoracic surgery used available civilian guidelines, military policy, and their experience in military medical practice to formulate consensus recommendations. Although medical principles and indications for surgical intervention do not differ between servicemembers and their civilian counterparts, the unique occupational constraints associated with active duty military service warrant special consideration in the context of ascending aortic disease. A specialist at a military treatment facility should be involved in decision-making about continued service for these patients. In the absence of familial or genetic association or a marked hypertensive response to exercise, most patients with ascending aortic dilation and some patients with ascending aortic aneurysm will be candidates to remain on active duty, with appropriate, patient-specific limitations. These recommendations provide a foundation on which to base individualized decisions for active duty patients with ascending aortic dilation or aneurysm.