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Abstract
Aneurysms may result in ratable permanent impairment, and this article provides a basic understanding of aneurysms and how to rate them using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. An aneurysm is a bulge in a blood vessel, commonly in the arterial circulation and in the cerebral and renal vasculature or in the aorta. Because ruptured aneurysms frequently are lethal, generally they are treated prophylactically once they have reached a certain size. Endovascular repair is associated with an increased risk of all-cause mortality and abdominal aortic aneurysm mortality. The AMA Guides, Fifth Edition, rated aneurysms solely on the risk of rupture (ie, a future impairment, one of the few exceptions to their general proscription in the AMA Guides), and the impairment percentages can be quite large. These impairments are rated using the rating systems for the affected organ system when the individual is at maximum medical improvement (MMI). In addition, the risk of future impairment should be assessed when the individual is at MMI, and that rating should be combined with the rating for organ system vascular compromise. The justification for rating the risk of future events should be clarified in the report, which should cite the method reported in the present article because the AMA Guides, Sixth Edition, does not provide a methodology for rating this disease process.
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1.
Rondinelli RD, ed. Guides to the Evaluation of Permanent Impairment. 6th ed. Chicago, IL: American Medical Association; 2007.
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2.
Gornik HL, Creager MA. Disease of the aorta. In: Topol EJ, ed. Textbook of Cardiovascular Medicine. Philadelphia, PA: Lippincott Williams & Wilkens; 2007:1473–1495.
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3.
Kern JA, Kron IL. Descending thoracic and thoracoabdominal aneurysms. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of Cardiothoracic Surgery. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkens; 2007:546–556.
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The United Kingdom EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1863–1871.
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The RESCAN Collaborators. Surveillance intervals for small abdominal aortic aneurysms. A meta-analysis. JAMA. 2013;309(8):806–813.
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6.
Jackson RS, Chang DC, Freischlag JA. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 2012;307(15):1621–1628.
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7.
Lederle FA, Freishlag JA, Kyriakides TC, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012;367:1988–1997.
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8.
Cocchiarella L, Andersson GBJ, eds. Guides to the Evaluation of Permanent Impairment. 5th ed. Chicago, IL: American Medical Association; 2001.
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