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

Introduction: 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 (advanced age, hypertension, smoking, atherosclerosis), making their coexistence relevant in an increasingly comorbid population. The lack of established guidelines necessitates careful multidisciplinary planning for optimal therapeutic choice. Materials and Methods: From March 2010 to March 2025, 11 consecutive patients (median age 75 years, 72.7% male) with coexisting AAA and renal neoplasm at Policlinico Umberto I, Rome, underwent surgical procedures. Interventions included simultaneous or staged surgical approaches. The median interval for staged procedures was 30 days (IQR -7.5 - 52.5). Diagnosis was primarily by angio-CT following incidental ultrasound findings. Preoperative assessments included standard cardiac evaluations; 4 patients (36.4%) required PCI and dual antiplatelet therapy, leading to staged procedures. Results: Median operative time for simultaneous procedures was 200 minutes (IQR 142.5-242.5). For staged procedures, EVAR median time was 100 minutes (IQR 45-165), and nephrectomy was 102.5 minutes (IQR 45-165). The overall median hospital stay was 8 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. 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. Conclusions: Managing concomitant AAA and renal neoplasm is complex due to its rarity and lack of clear guidelines. However, this study demonstrates that both simultaneous and staged surgical approaches (EVAR and nephrectomy) yield excellent long-term survival and low postoperative morbidity. These findings underscore the critical importance of a multidisciplinary approach and personalized therapy for each patient in this challenging clinical scenario.