Synchronous Presentation and Management of Abdominal Aortic Aneurysm and Renal Neoplasm: A Case Series Analysis

Background/Aim: The concomitant presence of abdominal aortic aneurysm (AAA) and renal cancer is a rare but increasingly diagnosed condition, often found incidentally. Despite distinct etiologies, both pathologies share common risk factors making their coexistence relevant in an increasingly comorbid population. The lack of established guidelines necessitates careful multidisciplinary planning for optimal therapeutic choice. Patients and Methods: From March 2010 to March 2025, 11 consecutive patients with coexisting AAA and renal neoplasm underwent surgical procedures at Policlinico Umberto I, Rome. Interventions included simultaneous or staged surgical approaches. The primary endpoints of this study were overall survival (OS) and disease-free survival (DFS). The secondary endpoints included: 30-day postoperative myocardial infarction (MI), postoperative acute kidney injury (AKI), surgical complications, endoleak occurrence, operative time, and length of hospital stay. Results: Overall survival (OS) at 24 and 36 months was 90.0% and 77.1%, respectively, with similar disease-free survival (DFS) rates. One patient (9.1%) had neoplastic recurrence at 24 months. Median operative time for simultaneous procedures was 200 min [interquartile range (IQR)=142.5-242.5]. For staged procedures, endovascular aortic repair (EVAR) median time was 100 min (IQR=45-165), and nephrectomy was 102.5 min (IQR=45-165). The overall median hospital stay was eight days (IQR=1-17). No postoperative myocardial infarctions, acute lower limb ischemia, or significant intraoperative hemorrhages occurred. One patient (9.1%) developed acute kidney injury managed conservatively. Three patients (27.3%) experienced type II endoleaks without requiring intervention. Conclusion: Managing concomitant AAA and renal neoplasm is complex due to its rarity and lack of clear guidelines. This study demonstrates that both simultaneous and staged surgical approaches (EVAR and nephrectomy) yield excellent long-term survival and low postoperative morbidity, underlining the importance of a multidisciplinary approach and personalized therapy.