2010 BC Guide in Determining Fitness to Drive

with age and is higher in close family relatives of those affected. Prevalence also is higher inindividuals with cardiovascular risk factors such as cigarette smoking, hypertension, andhypercholesterolemia.Deep-vein thrombosisThe prevalence of DVT is estimated to be < 0.005% in individuals less than 15 years of age, andincreases to approximately 0.5% for individuals 80 years of age and older. Approximately onethirdof patients with symptomatic DVT will develop a pulmonary embolism, which is theobstruction of the pulmonary artery or a branch of it leading to the lungs by a blood clot.12.3 Peripheral vascular diseases and adverse driving outcomesThere are no studies that consider a relationship between peripheral vascular diseases and risk ofcrash.12.4 Effect of peripheral vascular diseases on functional ability to drivePeripheral arterial diseaseFor individuals with peripheral arterial disease, the chronic outcomes of the disease will rarelyaffect fitness to drive. The symptoms of lower extremity PAD such as coldness or numbness inthe foot or toes, and in the later stages, pain while the extremity is at rest, may affect the sensoryand motor functions required for driving.In general, the degree of impact will be determined by disease severity. For example, individualswho are asymptomatic or have mild to moderate claudication are unlikely to have symptoms thatwould affect driving. Individuals whose disease has progressed to the severe claudication stageor higher may have functional impairment sufficient to interfere with the lower extremitydemands of operating a motor vehicle (e.g., awareness of foot placement, pedal pressure, motorstrength, etc.).Abdominal aortic aneurysm and aortic dissectionFor individuals with an abdominal aortic aneurysm, acute complications may affect fitness todrive. The primary concern with an abdominal aortic aneurysm is the risk of rupture. Themajority of aneurysms are asymptomatic and research suggests that there are few or nosymptoms prior to rupture. There is limited data on the immediate functional outcomes ofrupture (e.g. loss of consciousness). In the absence of firm data, it is assumed that mostindividuals experiencing a rupture lose consciousness almost immediately. As with AAA, theprimary concern for an individual with an aortic dissection is the risk of rupture.Size and rate of expansion of abdominal aortic aneurysms and aortic dissections are determinedby sequential CT or Ultrasound imaging. Only the anterior-posterior or transverse diameter ispredictive of rupture; the length of the aneurysm has no relation to rupture.114