Abdominal Aortic Aneurysm and Malignancies

Abstract

Concomitant AAA and abdominal malignancy are always very complicated conditions requiring early management of both pathologies. This is undoubtedly a dilemma for a surgeon who cannot currently rely on any large randomized trials or mandatory guidelines. When making decisions, a surgeon most often relies on personal experience, the experience of his/her center and/or limited literary guidelines and recommendations. Efforts should be aimed at achieving a consensual multidisciplinary decision about which pathology requires "more acute" management. The decision-making process is easier if one of the pathologies is life-threatening, and such pathology should be managed first. In most cases, however, AAA is asymptomatic and a malignancy is found randomly, as a secondary finding during the follow-up of AAA patients, or vice versa, AAA is found randomly during the staging of cancer patients. In these cases, the therapeutic algorithm already admits several possible variants. Endovascular repair of AAA (EVAR) resulted in an absolute change in the management of these patients. EVAR can be used in simultaneous or stage procedures with minimal time delay. Also, surgical open resection is an option (simultaneously or staged). It is necessary to know the advantages and risks of all approaches.

A systematic review and meta-analysis on the management of concomitant abdominal aortic aneurysms and renal tumours

“…5 The three main therapeutic approaches to concomitant aortic abdominal aneurysms and renal tumours described in the literature are as follows: one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy and two-stage endovascular aneurysm repair (EVAR) and nephrectomy. 6 Treating either one of these conditions first increases the risks associated with delaying the treatment of the other condition. However, performing a combined procedure dealing with both conditions at once may not be suitable for older and less fit patients.…”