Current surgical management of abdominal aortic aneurysm with concomitant malignancy in the endovascular era

Abstract

EVAR for patients with AAA and concomitant malignancy may be acceptable in terms of a short LOS and resulting in treatment for malignancy without delay.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

“…The reported incidence of concomitant malignant diseases and AAA is 5.4e6.7%. 757,758 It represents a challenging issue in terms of treatment priority, timing, and expected outcome. Most published papers consist of small case series.…”

“…Since open AAA repair prior to resection of a gastrointestinal cancer may result in a delay of months in comparison to days post EVAR, 759,764,766,757,767 the AAA should preferably be considered for EVAR if anatomically suitable followed by staged cancer surgery within 2 weeks. This would allow for a minimum delay in the treatment of both the aneurysm and the cancer, as well as a reduced risk of graft infection.…”

“…large aneurysm with advanced obstructing malignancy) and the anatomy is not suitable for endovascular repair, a synchronous open approach may be chosen, providing very high attention to detail (patient selection, blood supply to avoid bowel necrosis, irrigation, and omental wrap to avoid infection) realising that cumulative morbidity and mortality are higher in these single stage operations. 766 The overall survival rates post EVAR in patients treated for concomitant cancer are naturally poorer because of progression of the neoplastic disease and are influenced by type, stage, and grading of the malignancy: 50e66% at three years for colorectal cancer 757,768 and 15% at three years for lung cancer. 769 In lung cancer and pancreatic cancer, staging is crucial before considering AAA treatment because the overall survival correlates closely with the stage of these cancers.…”

Management of Concomitant Abdominal Aortic Aneurysm and Intra-abdominal, Retroperitoneal Malignancy

“…The incidence of abdominal angina after EVAR ranges in general from 1.5 to 3%. For patients with a tumour on the left side of the colon and rectum, during an EVAR it is important to preserve the patency of at least one internal iliac artery during exclusion of the inferior mesenteric artery for preservation of collateral circulation for this part of the intestine, which is essential for resections and the vitality of anastomoses in this area (19,20). If for various reasons this is not possible, it is better to choose an open operation, primarily for AAA with aneurysms in the iliac arteries with implantation of inferior mesenteric artery to preserve the vitality of bowel anastomosis in this area.…”

Synchronous sigmoid cancer and abdominal aortic aneurysm treated by laparoscopic colectomy followed by endovascular aneurysm repair

“…The occurrence of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC) presents a real management challenge. In such situation, the main controversy is the necessity of treating the diseases simultaneously or in two stages, if so in which order, and finally balancing between open or mini-invasive approach [ [1] , [2] , [3] ]. Recently, the introduction of endovascular AAA repair (EVAR) and the standardization of laparoscopic resection for colorectal cancer offer more benefits for this group of patients.…”