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Nielsen AC, Nicolajsen CW, Eldrup N. Abdominal Aortic Aneurysm Repair in Patients with Concomitant Cancer: A Literature Review. Vascular 2023:17085381231159151. [PMID: 36812403 DOI: 10.1177/17085381231159151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES Abdominal aortic aneurysmal (AAA) repair in patients with concomitant cancer is controversial due to increased comorbidity and reduced life expectancy in this specific patient group. This literature review aims to investigate the evidence supporting one treatment modality over another (endovascular aortic repair (EVAR) or open repair (OR)), as well as treatment strategy (staged AAA-, cancer first or simultaneous procedures) in patients with AAA and concomitant cancer. METHODS Literature review, including studies published from 2000 to 2021 on surgical treatment in patients with AAA and concomitant cancer and related outcomes (30-day morbidity/complications as well as 30-day and 3-year mortality). RESULTS 24 studies comprising 560 patients undergoing surgical treatment of AAA and concomitant cancer were included. Of these, 220 cases were treated with EVAR and 340 with OR. Simultaneous procedures were performed in 190 cases, 370 received staged procedures. The 30-day mortality for EVAR versus OR was 1% and 8%, corresponding to a relative risk (RR) of 0.11 (95% CI: 0.03-0.46, p = 0.002). No difference in mortality was observed between staged versus simultaneous procedure nor between AAA-first versus cancer-first strategy, RR 0.59 (95% CI: 0.29-1.1, p = 0.13) and 0.88 (95% CI 0.34-2.31, p = 0.80), respectively. Overall, 3-year mortality was 21% for EVAR and 39% for OR from 2000-2021, while the mortality up to 3 years after EVAR within recent years (2015-2021) was 16%. CONCLUSION This review supports EVAR treatment as first choice if suitable. No consensus was established on treating either the aneurysm or the cancer first or simultaneously. Long-term mortality after EVAR was comparable to non-cancer patients within recent years.
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Affiliation(s)
- Anne C Nielsen
- Department of Vascular Surgery, 53165Viborg Regional Hospital, Viborg, Denmark
| | - Chalotte W Nicolajsen
- Department of Vascular Surgery, 53165Viborg Regional Hospital, Viborg, Denmark
- Department of Cardiology, Thrombosis Research Unit, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, 53146Rigshospitalet, Copenhagen, Denmark
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Lawrie K, Whitley A, Balaz P. A systematic review and meta-analysis on the management of concomitant abdominal aortic aneurysms and renal tumours. Vascular 2021; 30:661-668. [PMID: 34137330 DOI: 10.1177/17085381211026827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The treatment of concomitant abdominal aortic aneurysms and renal tumours is controversial. The aim of this study was to ascertain which of the following three strategies, one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy or two-stage endovascular aneurysm repair and nephrectomy, is the best approach. METHODS systematic review and meta-analysis of articles published between January 1992 and April 2021 describing the treatment of concomitant abdominal aortic aneurysms and renal tumours. RESULTS A total of 1168 records were identified. After the selection process, 12 studies with data on 89 patients were included. Sixty-two patients underwent one-stage open procedures, 18 patients underwent two-stage open procedures and nine underwent two-stage endovascular procedures. The overall postoperative mortality was 0.82% (95% CI, 0.00-4.61). The postoperative mortality for one-stage open procedures was 3.09% (95% CI, 0.00-10.11). No deaths occurred in the postoperative period open two-stage procedures or two-stage endovascular procedures. The weighted postoperative morbidity for all procedures was 23.86% (95% CI, 12.64-35.08) and for open one-stage procedures was 37.40% (95% CI, 14.33-60.47). Data concerning postoperative complications of two-stage open procedures were extractable from only one patient in whom no complications were reported. Two postoperative complications were reported after two-stage endovascular procedures from a total of six patients with extractable postoperative data. We were unable to perform meta-analysis on long-term outcomes as the data were reported non-uniformly. CONCLUSION There is currently no evidence to suggest that any procedure is associated with better outcomes. However, a one-stage open approach was the most commonly used option, favoured as it avoids delaying treatment of either of the conditions. Two-stage open procedures were preferred in cases where the surgical risk of a one-stage procedure was higher than the potential benefit. For such cases, two-stage endovascular repair is becoming more popular as a less invasive approach.
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Affiliation(s)
- Katerina Lawrie
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Whitley
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Balaz
- Department of Surgery, 48370University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Vascular Surgery, National Institute for Cardiovascular Disease, Bratislava, Slovakia
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Studzińska D, Kózka M, Polok K, Gronostaj K, Chwała M, Szczeklik W. Prevalence of Renal Masses Suspected of Malignancy and Adrenal Incidentalomas in Patients With Abdominal Aortic Aneurysm. Vasc Endovascular Surg 2021; 55:793-797. [PMID: 34105407 DOI: 10.1177/15385744211022603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of our study was to assess the prevalence of renal masses suspected of malignancy and adrenal incidentalomas in patients with abdominal aortic aneurysm based on the computed tomography angiography (CTA). METHODS In the retrospective cross-sectional study, the CTA scans of patients with abdominal aortic aneurysms and thoraco-abdominal aortic aneurysms type II-IV were assessed. Patients with thoraco-abdominal aortic aneurysms type I and V and history of abdominal aortic surgery were excluded from the study. RESULTS Study group comprised 937 patients with a median age of 73.0 years, 83.8% of whom were male. CTA revealed renal tumors in 11 patients (1.2% of the study population) with a median size of 26 mm (interquartile range 20-50). Adrenal incidentalomas were found in 61 patients (6.5% of the study population). In 20 patients (2.1%) adrenal lesions were found bilaterally. CONCLUSION In the described cohort, the renal and adrenal tumors were relatively common findings among patients with abdominal aortic aneurysm and thoraco-abdominal aortic aneurysms type II-IV. Both anaesthesiologists and surgeons should be vigilant about the possibility of such coexistence in order to provide the patients with the best possible perioperative care and an optimal surgical modality.
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Affiliation(s)
- Dorota Studzińska
- Department of Vascular Surgery and Angiology, St. John Grande Hospital, Kraków, Poland.,Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Kózka
- Department of Vascular Surgery and Angiology, St. John Grande Hospital, Kraków, Poland
| | - Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Gronostaj
- Department of Urology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Chwała
- Department of Vascular Surgery and Angiology, St. John Grande Hospital, Kraków, Poland.,Clinic of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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Peeters B, Moreels N, Vermassen F, van Herzeele I. Management of abdominal aortic aneurysm and concomitant malignant disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:468-475. [PMID: 30916530 DOI: 10.23736/s0021-9509.19.10946-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Concomitant malignant disease and abdominal aortic aneurysms (AAA) represent a challenging issue in terms of treatment priority, timing and perspectives. This systematic review provides an overview of the available literature about AAA and concomitant malignant disease. EVIDENCE ACQUISITION We conducted a literature search of all the English-language medical literature in Medline (through PubMed), Embase, Clinical Trial databases and the Cochrane Library up to December 31st, 2018. EVIDENCE SYNTHESIS The literature about AAA and concomitant malignant disease is mostly based on retrospective small case series. Two recently published meta-analyses focusing on the management of AAA and concomitant abdominal neoplasms came to the same conclusion "treat what is most threatening or symptomatic first." The threshold to treat asymptomatic AAA should not be altered in patients with AAA and concomitant cancer including cases under chemotherapy. An asymptomatic AAA of at least 55 mm anatomically suitable for EVAR, should only be treated first in patients with at least a life expectancy of two years followed by staged cancer surgery two weeks later. CONCLUSIONS Decisions about management of AAA and concomitant malignant disease should be based on clinical judgment applied individually in a multidisciplinary setting ("treat first what kills first"). The indication for treatment is not different than in patients with AAA without cancer. A staged approach is preferable and ideally the AAA should be excluded by endovascular means if anatomically suitable. An international registry should be initiated to gather more evidence about the management and outcomes of patients with AAA and concomitant carcinoma.
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Affiliation(s)
- Bernard Peeters
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium -
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Kotsis T, Dellis AE. Surgical Repair of Abdominal Aortic Aneurysm in Patients with Simultaneous Urological Disorders: a Single Center Experience. Med Arch 2018; 72:230-233. [PMID: 30061774 PMCID: PMC6021157 DOI: 10.5455/medarh.2018.72.230-233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Although rare, co-existence of abdominal aortic aneurysms with urological manifestations, suggests a challenging surgical entity in terms of successful aneurysmal repair along with minimally or null urological complications. Case reports There are neither available data regarding the incidence of their co-existence nor consensus regarding optimal surgical management. Given the infrequency of their simultaneous presentation, the report of unusual cases as well as proposal for successful surgical management, are always useful and educative. Conclusion Precise imaging pre-operatively and meticulous surgical technique intra-operatively are of utmost importance and suggest our vast allies in successful outcomes. Herein, we present our small case series of 3 interesting cases.
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Affiliation(s)
- Thomas Kotsis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios E Dellis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
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Meta-analysis of Outcomes Following Aneurysm Repair in Patients with Synchronous Intra-abdominal Malignancy. Eur J Vasc Endovasc Surg 2016; 52:747-756. [PMID: 27592036 DOI: 10.1016/j.ejvs.2016.07.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/20/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The management of concomitant intra-abdominal malignancy (IAM) and abdominal aortic aneurysm (AAA) remains a challenge, even though malignancy is common in an elderly population. By means of systematic review and meta-analysis, the aim was to investigate outcomes in patients undergoing open (OAR) or endovascular AAA repair (EVAR) that have a concomitant malignancy. METHODS A systematic literature review was performed (Medline and EMBASE databases) to identify all series reporting outcomes of AAA repair (OAR or EVAR) in patients with concomitant IAM. Meta-analysis was applied to assess mortality and major morbidity at 30 days and long term. RESULTS The literature review identified 36 series (543 patients) and the majority (18 series) reported on patients with colorectal malignancy and AAA. Mean weighted mortality for OAR at 30 days was 11% (95% CI: 6.6% to 17.9%); none of the EVAR patients died peri-operatively. The weighted 30-day major complication rate for EVAR was 20.4% (10.0-37.4%) and for OAR it was 15.4% (7.0-30.8%). Most patients had their AAA and malignancy treated non-simultaneously (56.6%, 95% CI, 42.1-70.1%). In the EVAR cohort, three patients (4.6%) died at last follow-up (range 24-64 months). In the OAR cohort 23 (10.6%) had died at last follow up (range from 4 to 73 months). CONCLUSION In this meta-analysis, OAR was associated with significant peri-operative mortality in patients with an IAM. EVAR should be the first-line modality of AAA repair. The majority of patients were not treated simultaneously for the two pathologies, but further investigation is necessary to define the optimal timing for each procedure and malignancy.
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Treatment of Abdominal Aortic Aneurysms in Cancer Patients. Ann Vasc Surg 2016; 30:159-65. [DOI: 10.1016/j.avsg.2015.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/04/2015] [Accepted: 07/18/2015] [Indexed: 11/22/2022]
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Mehta TA, Miller FN, Boyle JR. Myeloid sarcoma infiltration of aortic stent-graft causing chronic hemorrhage. J Endovasc Ther 2012; 19:565-7. [PMID: 22891843 DOI: 10.1583/11-3444r.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To report a rare case of myeloid sarcoma infiltration of an aortic stent-graft causing chronic hemorrhage and mimicking stent-graft infection. CASE REPORT A 90-year-old man presented 8 years after endovascular aneurysm repair with general malaise, nausea, abdominal pain, and hyperbilirubinemia. His inflammatory blood markers were elevated, and an abdominal computed tomography (CT) scan showed unusual fluid and soft tissue collection around the stent-graft. A presumptive diagnosis of stent-graft infection was made, and he was started on intravenous antibiotics because he was not fit for surgery. His condition gradually deteriorated in hospital. Four months later he died of sudden hemodynamic collapse and shock. Postmortem examination revealed large malignant periaortic lymphadenopathy with suggestion of stent-graft infiltration and chronic hemorrhage. Histology of the lymph nodes confirmed myeloid sarcoma. CONCLUSION Soft tissue and fluid collections around an aortic stent-graft on CT are not always indicative of a graft infection; malignant tumors, although rare, should be considered.
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Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery. Updates Surg 2012; 64:125-30. [PMID: 22407592 PMCID: PMC3360141 DOI: 10.1007/s13304-012-0137-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 02/21/2012] [Indexed: 11/01/2022]
Abstract
Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.
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Zanow J, Leistner Y, Ludewig S, Rauchfuss F, Settmacher U. Unusual course of an abdominal aortic aneurysm in a patient treated with chemotherapy for gastric cancer. J Vasc Surg 2012; 55:841-3. [DOI: 10.1016/j.jvs.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/11/2011] [Accepted: 09/03/2011] [Indexed: 11/29/2022]
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