Is it safe for individuals with an aneurysm (abnormal dilation of a blood vessel) to fly?

Safety of Air Travel for Individuals with Aneurysms

Individuals with unruptured aneurysms can generally fly safely, but the decision should be based on aneurysm size, location, and stability, with consultation from a neurosurgeon or vascular specialist before travel. 1

Risk Assessment for Cerebral Aneurysms

The safety of flying with an aneurysm depends primarily on:

Aneurysm Characteristics

• Size: Larger aneurysms carry higher rupture risk

  • <7mm in anterior circulation with no history of SAH: very low rupture risk (0% per year) 2
  • <7mm in posterior circulation or posterior communicating artery: higher risk (2.5% per year) 2

  • 7mm: significantly increased rupture risk regardless of location 2

• Location: Posterior circulation and posterior communicating artery aneurysms have higher rupture risk 2

• Morphology: Aneurysms with irregular shape, daughter sacs, or deviated necks have higher rupture risk 2, 3

• Stability: Recent growth on imaging indicates higher risk 4

Patient Risk Factors

• Previous subarachnoid hemorrhage (SAH) increases risk 2
• Family history of aneurysms 2
• Combined history of SAH and familial intracranial aneurysms significantly increases risk (RR 10.1) 4
• Hypertension 2
• Smoking 2

Recommendations for Air Travel

For Untreated Aneurysms:

• Low-risk aneurysms (small <7mm, anterior circulation, no history of SAH, stable size):

  • Generally safe to fly
  • Consider consulting neurosurgeon before travel

• Moderate to high-risk aneurysms (larger size, posterior circulation, history of SAH, or recent growth):

  • Consult with neurosurgeon before travel
  • Consider treatment before extensive air travel
  • If travel is necessary, ensure blood pressure control during flight

For Treated Aneurysms:

• Post-surgical clipping or endovascular coiling:

  • Generally safe to fly after complete recovery
  • Ensure follow-up imaging confirms adequate treatment 2
  • For patients with flow diverters, ensure compliance with antiplatelet therapy 5

• Post-treatment monitoring:

  • Follow-up imaging is recommended to identify remnants or recurrence that may require further treatment 2
  • Even completely treated aneurysms carry a small risk of recurrence 2

Practical Considerations During Air Travel

• Blood pressure management: Maintain good control before and during flight
• Avoid activities that increase intracranial pressure:
  • Heavy lifting
  • Straining
  • Excessive alcohol consumption
• Hydration: Stay well-hydrated during flight
• Medication: Bring all necessary medications in carry-on luggage
• Medical information: Carry documentation about your condition and treatment

Special Considerations for Abdominal Aortic Aneurysms (AAA)

• Patients with asymptomatic and/or surgically corrected AAA can safely travel by commercial aircraft 1
• For untreated AAAs, regular surveillance is recommended:
  • Every 6 months for 4.5-5.4 cm diameter
  • Every 12 months for 3.5-4.4 cm diameter
  • Every 3 years for 3.0-3.4 cm diameter 2

When to Avoid Air Travel

• Recently diagnosed, large, or symptomatic aneurysms that haven't been evaluated
• Recent subarachnoid hemorrhage without definitive treatment
• Aneurysms showing rapid growth or new symptoms
• Immediately after aneurysm treatment (follow physician's guidance on timing)

The risk of aneurysm rupture during air travel specifically has not been well-established in research, but applying general principles of aneurysm risk assessment provides a reasonable approach to travel decisions.