Concomitance abdominal aortic aneurysm and cancer: vascular surgeon dilemma. Retrospective analysis and literature review

Introduction: The coexistence of abdominal aortic aneurysm (AAA) and cancer presents a complex clinical problem that requires careful consideration and individualized treatment approaches. Understanding the optimal management strategy is essential to ensure effective and safe treatment outcomes. Materials and methods: Retrospective analysis of every patient treated for AAA in the Department of Cardiac and Vascular Surgery, Medical University of Gdansk, between January 2017 and January 2023. Analysis of medical data in the hospital system, confirmation via telephone interviews. Inclusion criteria: Patients with indications for surgical treatment of AAA and malignant disease treated surgically. Exclusion criteria: Patients treated conservatively and in the terminal stage of malignancy. Patients without complete medical records or insufficient follow-up information. Results: The study included 590 patients. 23 subjects had indications for surgical treatment of AAA and malignant disease. 14 patients were treated by OAR and 9 by EVAR. 30-day mortality in both groups was 0%. Overall, long-term mortality (median 3 years) was 13% based on hospital system information, in the EVAR group 11% and 14% in OAR. There was no statistically significant difference between the OAR and EVAR group (p = 0.41). The authors later attempted to confirm the long-term mortality via telephone interviews, and the confirmed survival rate was 43%. Conclusions: Concomitant AAA and abdominal malignancy is a dilemma for a surgeon who cannot currently rely on any large randomized trials or mandatory guidelines. In the present observation, patients are treated for AAA in the first line too often, which increases mortality, and there is no difference in mortality between the OAR and EVAR-treated groups.