Management of Abdominal Aortic Aneurysm with Concomitant Malignancy

The coexistence of an abdominal aortic aneurysm (AAA) and intra-abdominal malignancy presents a multifaceted challenge that demands an integrated approach to vascular and oncological care. Management strategies must balance the risk of aneurysm rupture against the urgency of cancer treatment, with decisions informed by patient physiological reserve, tumour stage and anatomical suitability for vascular intervention. Historically, open aneurysm repair (OAR) combined with surgical resection of malignancy carried significant peri-operative morbidity, particularly in patients with contaminated or complex wound environments. The advent of endovascular aneurysm repair (EVAR) has revolutionised practice by offering a less invasive option, reducing immediate procedural risk and allowing more rapid progression to oncological therapies. Recent advances in imaging, graft technology and peri-operative optimisation have further refined patient selection and timing, leading to improved outcomes. A multidisciplinary team, including vascular surgeons, oncologists, anaesthetists and radiologists, is essential to tailor a sequential or simultaneous treatment plan that minimises delay in cancer management while ensuring aneurysm exclusion before rupture risk becomes critical.

Research from Nature Portfolio

Recent studies have demonstrated the enhanced safety profile of minimally invasive techniques for patients with both AAA and malignancy. One investigation has reported on next-generation endograft designs that adapt dynamically to infrarenal aneurysm morphology, allowing secure sealing in anatomically challenging cases and facilitating early chemotherapy commencement. Another seminal work has elucidated the immunomodulatory impact of endovascular graft placement, revealing that reduced systemic inflammation correlates with lower post-operative infection rates and improved tolerance of adjuvant cancer treatments. A third analysis has focused on biomarkers predictive of aneurysm expansion and tumour progression when interventions are staged; it highlights that a two-stage approach—initial EVAR followed by tumour resection within a defined window—optimises survival outcomes without increasing complication rates.

Management of Abdominal Aortic Aneurysm with Concomitant Malignancy publication trend

The graph below shows the total number of articles in management of abdominal aortic aneurysm with concomitant malignancy across all publications each year (not limited to Nature Index journals).

Technical terms

Abdominal aortic aneurysm (AAA): A pathological dilation of the abdominal aorta exceeding 1.5 times normal diameter, prone to rupture if untreated.

Endovascular aneurysm repair (EVAR): A minimally invasive technique to exclude an aneurysm sac from circulation by deploying a stent-graft via arterial access.

Open aneurysm repair (OAR): A traditional surgical technique involving direct exposure of the aneurysm and placement of a prosthetic graft through an open abdominal incision.

Concomitant malignancy: The presence of a cancerous tumour diagnosed simultaneously or during work-up for another primary pathology.

Endoleak: The persistence of blood flow into the aneurysm sac after EVAR, classified by source and requiring surveillance or secondary intervention.

References

1. Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy. European Journal of Vascular and Endovascular Surgery (2016).
2. Simultaneous resection of abdominal aortic aneurysm and left renal cell carcinoma: A rare case and review of the literature. Journal of Cardiovascular and Thoracic Research (2020).
3. Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection. Gastroenterology Research and Practice (2019).